HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABIL INFq MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� l (� Permit Number:
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:
Legal Description: Cl til,b PiQ4 dIL Ornk B) X
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PropertyTax ID#: 2 U - ��I ' �S` U (� —�j Lot No. 2-
Site
Site Plan Name: pp Block No.
Project Name: S i n irz S 7 &a/ �.�
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Additional work to be nertormed under this permit-check all t=appy: �I
❑HVAC Gas Tank Gas Piping _Shutters ❑ 9 indows/Doors
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Electric ❑ Plumbing ❑Sprinklers ❑Generator !RoofEQJ_�Roof pitch
Total Sq. Ft of Construction: �/� S . Ft.of First Floor:
Cost of Construction:$ 9/D(% ' Utilities:�Sewer❑Septic Building Height:
/LESS b � V, 3. CC+NT��CTaR
Name n L414 1 0 n JL0Name:
Address:2S V b �� I � 1/1 cf h LCompany: i ►'�C� c> 1'1
City: State: Address: Ql SL� S• d '
Zip Code: Fax: City: S ) Stat
Phone No. Zip Code: Fax: 3r1 !J
E-Mail: Phone No. � 1��
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) state or County License: (f
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY= _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phonel
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:]
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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 covenantsjthat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any rest fictions 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 Amendm'e' nts.
The following building permit applications are exempt from undergoing a full concurrency reviev-: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'' posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an a torney before
commencing work or recording our Notice of Commencemen
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Signature of Owne Lessee/Contractor as Agent for Owner Signature of Contractor/License H
STATE OF FLORIDA- STATE OF FLORIDAr�,
COUNTY OF &TJ i'1 C,-,, COUNTY OF o' 1
The or oing instru ent was acknow dged before me The Ming in
The acknowledged before me
this(day of 20 laby this day of (QGh 7 I,rf1 r"' 20 10 by
boo] � _oD:iPt1r)
(Name of pero acknowledging) (Name of person acknowled g)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
5 516 - (01 V- 8 0
Personally Known OR Pr clucecl Identification V Personally Known OR Produced Identification
Type of Identification Produced Drj Type of Identification Produced
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Commission No. lo"P c�ySea"otaryPublic State ofFlo dGO ission Nor 6!/ ^ Not0 NcStateofFlorid.
Jennifer Davis Jennifer Davis
My Commission FF 9660 9 po` My Commiasion FF 966029
Oi FL
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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