HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` u
Date: 23 Permit Number: '� 1 1�
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line c�L
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Address:
Legal Description:
Description:
Property Tax ID#: ��� ' da J d36� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit—check all that appy:
XHVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construct n: Sq. Ft. of First Floor:Cost of Construction. Utilities: —Sewer _Septic Building Height:
Name _Ac e c,
14 i^e--c- Name: vie— 0
Address: e) Company:" �o�� i
City: �� r°i'.,^2'_ State: -=t, Addre Jc ; -s Leu-
Zip
pp
Code: Fax: City: or State: F;-
Phone No(,12-309'1 71L Zip Code:3qc/ Fax:
E-Mail: Phone No. ��� m 1,
Fill in fee simple Title Holder on next page (if different E-Mail:ovicc--4 c9e)�i � '� �:�e•�+e
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTa� CONSTI CTIQN l.lEl� LAW INFORMATIC?N:
�
/ = .App MORTGAGE COMPANY: Not ENGINEER: Not Applicable of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or ref3,pfing your Notice of Commencement.
S_
ure of Own r/Lessee/Contractor as Age for Owner Sig t of Contractor/License Holder
STATE OF FLOOR DA STATE OF FLOR DA
COUNTY OF D . L\) 'tA` COUNTY OF - L\ cC ',
The forgoing instryment was acknowledgbefore me The forgoing instrument was acknowledged before me
thisa�day of ,J a 201 by this�� day of713 `n 20 J_�_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub c-State of Florida ) (Signature of Notary Publl -State of Florida)
Personally Known Personally Known Rro uc
Type of Identification n+ t i 1EGIVENs Type of Identification ] NA ►EG
MY WMM1bb1UN;F U;.UZZUa '" 1>00 0 i
it ='r bP' EXPIRES 22D?.3
EXPI OD�Q(�tuber 16,2020 ' Bond ! ece 16,202(1
Commission No p' BondedTh�ttbtd+yPublicUnderwrHors COmmI5510n NO. � ,, � �1 bkundenwil.,;
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS