HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: •Z." l 3_I'l Permit Number: '
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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
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Address: 4 - �� • ��^� �- `t �,S
Legal Description:
Property Tax ID#: 5-1( 1.15 Lot No. (
Site Plan,Name: Block No.
Project Name: C-14r,0 r\.-e- ; �1 _
Setbacks Front Back: Right Side: Left Side:
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itiona wor to e e orme un er t is permit-c ee a r app y:
�NVAC �Gas Tank ❑Gas Piping _Shutters �ll/indows/Doors
Electric Plumbing �Sprinkiers Generator Roof Roof pitch
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Total Sq.Ft of Construction: S Ft,of First Floor:
Cost of Construction:$ 2.-..3 nle Utilities:0Sewer E]Septic Building Height:
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Name r_,-4_ l e e v QuT' ^ A,e_ Name: Lirlh T�Jc"Y--, 4
Address: KA hs Kc.. fir- Company: 6be
City: 1-1,-ednt, Stater Address:3 Z.31 L bo .r n:• "'("�r,�
Zip Coder Fax: City: Stater
Phone No---b-,DC)- 571 Zip Code: r 15:1 Fax:
E-Mail: Phone No.'?7 7_-')7t
Fill in fee simple Title Holder on next page(if different E-Mail:_ E-b (�- 6a ti f S _ Ce z ON
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ at Applicable MORTGAGE COMPANY: 4Not Applicable
Name: Name:
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Address: Address:
City: State: City: , State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: !Nat 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 pasted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Wttx>n COUNTY OF_A6V+f/1
The forgoing instrument was acknowledged before me The f org ing instrument was acknowledged before me
this Z1 day of�Gmbc/ 2011P by this2-7 day of_rZM Int.✓ ,201(P by
CcJ 1 1�l i Jc.►�-rj I� Lor
(Name of person acknowledging) (Name of person acknowledging)
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nature of Notary Public/-State of rida) (S' ture of Notary Public-State of Florid )
Personally Known VOR Produced identification Personally Known Lf"®R Produced Identification
Type of Identification Produced Type of identification Produced
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rF131 $3tP SHAWNAM. fission No. /31of,� (Seal)
Commission No. (S � ), S1�4WIJA�
NOTARYPU UC g a
STATE OF ORIDA NOTARY PUB!!
Comfn#FF131&168TATE OF FLOR A fi
Revised 07/15/2014 f i Expires 6/1112018 FF131
E ire8 6/111221
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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