HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6' /,4/ 2- Permit Number:
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owiloing rermt Hppiicatllon
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 3498" Residential 1
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERM I APPLICA I ION FUR: To Select frorn dropbox, click arrow at the end of line i
PROPOSED IMPROVEMEN I LOCAL ION:
Address: ' y� 7232t
Legal Description:
L'6' Lot No. _
Property Tzx ID ��7 h7L - V G
Block No._
Ste Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side: -
DE I AILED DESCRIP I ION OF WORK:
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CONSTR CTION INFORMATION:
ad�t10 wor to ea—erforme�c un er t is permit-c eck afT app y
H VAC Gas Tank Gas Piping L1 Shutters aWindows/Doors
p
❑_Electric Plumbing
Sprinklers El Generator Ll Roof Roof pitch
Tota Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: []Sewer D Septic Building Height:
CONTRACTOR:OWNER/LESSEE: C ---
Name 0 be i e'• Name: CUVCTIS 15AakDncnJr,
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u -ro K A em"S
Address: t/ /1 r- Com pany:
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City: U2T�7 .�///'�_e State:�L Address: /i'l$ 6S \Z Il aq-e �( ee11 �� I
Zip Code: Fax: City:
Pc%R-t 9t. E uct -- State:
Zip Code: 3`I-4 S)- Fax: 77.?- J 3 5-1 q I
Phone No.
E-Mail: Phone No. '1 3 3 S 3 2 3
Fill in fee simple Title Holder on next page{ if different E-Ma.l: u 8 t c1 I f- Sys .P Cc o c [,vn i
from the Owner listed above) State or County License: CC? 5 F r 0
if value of eoostruction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEN JAL CONS 1 RUC:I ION LIEN LAW INFORMAL ION:
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: j
Address: Address:
City: State: City: State: I
Zip: Phone: Zip: Phone:
1
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: i
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 Horne 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 rec , ding your Notice of Commencement.
s ,
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder j
STATE OF FLORIDA n / STATE OF FLORIDA f
COUNTY OF V 2� , U el e_ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /`/day off 20 L-07bv this IV day of Acu y' 120 by
tqI7i Mori S" C�uIZTI 5 �nmmon S
(Name of person acknowledging) (Name of person acknowledging) I
(Signature of Notary Public-State of FI a) (Signature of Notary Public-State/of Flori
Personally Known_'.'�_OR Produced Identification Personally Known OR Produced Identification i
Type of Identification Produced Type of Identification Produced /
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Commission No.lJ1 05 116 CHRISTINEB emission No. ��c',
* * MYCOMMISSION/ 0525�6 °� c:. 711
EMRFS:Apt .2021_ Y ,--- �`• c ', �«vkw
C�R 6ondaa TMu Budget potty Snvius r"'-.
Revised07/15/2014 * * MYCOMMI&SMIGaOWN
E>4'IRES:Apt 4,2101
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REVIEWS FRONT ZONING SUPERVISOR 'f PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW ! REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS i