HomeMy WebLinkAboutBuilding Permit Application .I
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ALL APPLICABLE iNF -MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED s
Dater d :Permit Number.
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Building Permit Application
Planning and Development Services
Building-and Code-Regulation Division
2300 Virginko Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax:(772).4.62-1578 Commercial Reidential /
.PERMIT APPLICATION F.OR � p
To Select from dro boxi click arrow at they nd of fine
ED IMIEMRITIOCATICl4 j,._Y N T a� F t
Address, �`�4�
Legal Description: I0,50AC) (CR31"15 •-;?1 Yq)
Property Tax ID Cot No.
Site Plan Name; Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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RfTAIL�ED DESCRiPTIQi�I C91~�WDI�K � €. � ''` t � ,` f`;
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Q U . ana lam s ill `C/Je, For
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G_QI�STI�I��C�G10�V_ l�lFf7RMATCON ; _ '�4 �' '�
Acklitional vigor ,to bet'vertormed un ert �s permit-c ec a appy.
HVAC _Gas Tank ❑Gas Piping Shutters jQ Windows/Doo"rs
�E(ectric ❑Plumbing �Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S S . Ft.of First Floor:
Cost of Construction..$. 3a,, 600 Utilities _Sewer _Septic„j Building Height:
Name. .If- L.ubPi# C ` Il IaJbpi4- Name: rh1
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Company:
UM+7t
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City: %GE=C Q\Ba e, State: L Address: rn ?1- 417 U-14
Zip Code: Fax:- City: , 11�� State:_F_t
Phone No. 74-Ta- "6 9-5--5951 Zip Code: Fax:
E-Mail: Phone No. .3-(Q6 Dg - V;5 F
Fill in fee simple Title Holder on next page(if different E-Mail: NeXI L GLC- W-kl
from the Owner listed.above) tat or'County Lieense 'I
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If value of construction.is 52500 or more,a RECORDED Notice of Commencement is requirecll
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.SU L-t�IENTAL U
DESIGNER/ENGINEER: �Mt.Applicable MORTGAGE COMPAN I: Not Applicable
!Name: Name:
Address: Address:
City-, State: City: .I State.:
Zip, Phone- Zip: Phone':
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FEE'SIMPLE TITTLE HOLDER: "Not Applicable BONDING COMPANY:, Not Applicable
Name: Name: I
Address: Address:
City: City.: I
Zip: Phone: Zip: Phoned
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OWNER)CONTRACTOR AFFIDViT:-Application is hereby made to obtain a permit to do l.E
the work and installation as in"dicated.
i,certify that no work or installation has comrnenced prior to the issuance of a.permit.
StAucie Count makes,no,representation thatAs granting a permit will authorize the permit holder to build the subject-structure
which"is lb,conict with any applicable Home Owners Association.rules;bylaws or and covenant's 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 ofthe granting_of this recquested,per'rnit,I do-hereby agree that Lwill,in all respects,perform the work
in accordance:with the approved plans,:the Florida Building Godes and St.Lucie County Amendments.
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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 t6 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 Commencemerit must be rectirded and posted on the jobsite
b'efo're the first-inspection. If you intend to obtain financing,consult'with lender or an attorney'before
commencing w.ork.or recording our Notice of Commencement. II
Signature df Qwner%Lessee/ tractor-as Agent-for Owner Sign a of Contr tic nse Holder
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STATE.OF FLORIDA .STATE OF FL, IDA ( ,
COUNTY OF ='r ��UlSi6l COUNTY OIF Uatysi0
The forgoing instrument was:ackhowledged before me The forgoing instrument was acknowledged before me:
this L11f1day of 0(:J1 ,20(- by this_ ay of UGT '� ,201' by
UZ.Z t � peYaOAil UZ i 0-4�2iI do
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Name of person making statement Name of person making statement
Personally KnownOR Produced identification PersoriallyKnown OR Produced identification
Type.of Id_entificaton Type of Identification
Produc y�•G ' Produced 1--f e-
{Sign 'ur cifl\! taryPublic-State of Ct 7 A p TLt T C�)'t f Notary Public;'-5tafe of Fi'orida)
,,aaAt 4N°�`1'�id E{.IZAyE .H 1' EY1NO -
Commission No. ly Kffl =y a Commission# 'tCe»+�e�ss' n 1 0. GG. rf Cn1�5� `p��tiR''ru`4f��se
@ IZAQETN 1'RE1/I
MY.Commisaio r Expires. iii�
Commission#eG d 8Nq{/Qi1j1y9r 1 .'2020 My Commission Exp r
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ' SEATURTLE MANGROVE
COLINTER REVIEW REVIEW REVIEW REVIEW
REVIEW' REVIEW
DATE it
RECEIVED
DATE i
C61VIPI_Ef ED
ReV.81,2/17
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