HomeMy WebLinkAboutBUILDING PERMIT All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300'Virginia Avenue, Fort Pierce EL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: la
Address: -��'�� ��"��� ����-
Legal Description: ._.Lr J C x/ � i f�( E '✓ig y-, ��T
Property Tax iD#: -5LIDA ' b DY ' OR5G - CX)Q -Y Lot No. c;LL-P
Site Plan Name: Block No.��
Project Name:
Setbacks Front Back: Right Side: Left Side:
-111111110
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,Additional work to be per orme- under this permit—check all that apply:
4'Mioechanical _Gas Tank _Gas Piping _Shutters `Windows/Doors
_Electric _Plumbing _Sprinklers _Generator `Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer i Septic Building Height:
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Name C + �6-tt_y -
Name: J C n—op—l�- Sn e.✓
Address: DZ� �SC'�TCompany: � �e�v�.� (';,Ia
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City: a- P, State: Address: ( c2o �
Zip Code: 3061 Fax: City: -y-ZE!� State:F_
Phone No. tP'1 6 Zip Code: ` Fax: X
E-Mail: — Phone No y7 - D ` :3 7 7
Fill in fee simple Title Holder on next page (if different E-Mail S/)L , �Cf7d+ f1 to
from the Owner listed above) State or County License CIACA
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable (MORTGAGE COMPANY: dt Applicable
Name:
Name: �N. pp
Address: Address:
City. State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: y Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencin w k or cording our Notice of Commencement.
S' •at of Owner/Lessee/Agent re of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF nk LLB i COUNTY OF
The far�r ping instrument was acknowledged before me The for oing instru nt wa acknowledg d before me
this r- r day of �eQ F, 20n by this_day of 20�7 by
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{Name of person acknowledging} {Name of person acknowledging}
lS5! ••�' !r
{Signature gf,Nr to y Pu p-. of Florid_ �yU �NaCY2, ��•. ( gnat oaff o r_yp Pu{{}y��lic- to FI 4N l. ^/f��f''�✓✓
J � �• fly• � ti • .1���7Ji�ly• �' `�i
Personally Known OR Produced Id #�Jijcati 'iPeuonally Known QR Prod u ed} ? i�i'v�t
Type of Identification rQ.�•, W37 �T�e of Identification * ; �
Produced 'ytA:? +tle sa�44 toduced Q — f #FF 1953,a
�� � / �f✓� �� a s �aN� *�` Commission No. 1 q 4bs �. •QQ4�;
Commission No. {Seal) �� ii� 3 r r
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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