HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )i 1,'3O O 11 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division BY: """"""""•••••••
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: Z R57- 0,95 f'
ZLeal Description: dim 1,1cy— -- C)/?/ 'T O - Lr- 19 LoT -1 S rJw�Q 3y aS
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Property Tax ID#: 3107_ &W-1 -00/57 0c)y 57 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme un er is permit-c ec a appy:
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HVAC Li Gas Tank Gas Piping _Shutters Q Windows/Doors
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UN Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ /-3-0 v.,2 Utilities.1i Sewer F]Septic Building Height:
Name /ZD6g1ZT �. (7IZU:n/�r,5 Name: K�1V/1/�`TH 6E,eFM2i9
Address:Z/3 E E45Y ST- company: �'ViMfL A FC.FC-7;eXC�4_ �
City: (IOAC4!5 State: Address: MA/,_���i�ti'1S� AR,
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Zip Code:3q 9 8 2. Fax: City: State: fL
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Phone No.77Z-Zo ' lG o & Zip Code:3`1 � �o Fax: -777-3'/0-7Y75-
E-Mail: Phone No. Z-Z�� Z/9T
Fill in fee simple Title Holder on next page(if different E-Mail: )7 IJ i I (a/,C1 C,eerecco . Com'/
from the Owner listed above) State or County License: SL G z,17
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: Not Applicable
/ PP MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not 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 posted on the jobsite
before the first inspection. If yoy intend to obtain financing, consult with lender or an attorney before
commencing workpr recordin our Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF -S/, 1.L.,C,i f— COUNTY OF �l- LuGie—
The forgoing instrument wa acknowledged before me The forgoing instrument was L acknowledged before me
this ' da of w�04,c- 20 J b thls,��day of .4004441-- 20 E by
y /� y
�P nil 6l /t
(Name of person acknowledging) (Name of person acknowledging)
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(Si u e of Notary Public-State of Florida) (Signa a of Notary Public-State of Florida}
Personally Known OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Produced C Type of Identification Produced
Commission No.C' o9�93 6 Commission No.
JEANNE K MATTING �►'"^ ;: JEANNE K MATTING
Revised 07/15/201 %:fie. EXPIRES May 28,2021 EXPIRES May 28.2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS f
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