HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' a Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34582
Phone: (772) 462-1553 Fax: (772) 462-3578 Commercial Residential t✓
PEKMI 1 APPUCA i ION FOR: To Select from dropbox, click arrow at the end of line
NROPOSF_L)_IMNKUVF-MFN I LOCAI ION:
Address: 13 q $ m Gti r \C A-
Legai Description:
PropertyTax ID #: 30�� `l —' — �Ud Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L)LIAIL1=L) UF_SCKIPIION OF WORK:
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CONSTRUCTION INFORMATION:.
Add ona wo o e Dertorm under this permit - c ec a apply:
HVAC []Gas Piping Shutters a Windows/Doors
Gas Tank _
U Electric Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: // !! Sq. Ft. of First Floor:
[] F� Height
Cost of Construction: $ `'t Utilities: Sewer Septic Building
OWNER/LESSEE: —
CONTRACTOR:
Name i Name: 6Z(S ,S�rVt��onS
Address: l 39 gS l77 0.r 1' 1►S Company: C u sT& M A S'4 S � eytl; l a.: c: I
1, 1 �t t d G{recr� p r
City: Ebr+ J�. lUC FP State: r Address: S tll l Q.
Zip Code: y��q Fax: City.�y FLT St . 1_ ucc � State: te-
Phone No. Z (,P 06- �PL iZ1 Zip Code: a Q 52 - Fax: 77,2. .j
Phone
E-Mail: Phone No. `l d 3 S- 3 2 3 1
Feil in fee simple Title Holder on next page { if different E-Mail: � � S t GL i r s ti s � C< n 1 C C. vn
from the Owner listed above) State or County License: 9 l 0 i
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ff value of construction is $2500 or more, a RECORDED Notice of Commencement is requ"n"ed.
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SUPPLEM EN I AL CONS I RUC I ION LIEN LAW INFOKMA 1 ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable I
Name:
Name:
Address:
Address: i
City: State:
City: State:
Zip: Phone:
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address: I
City:
City: I
Zip: Phone:
Zip: Phone:
1 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 exenmptfrom 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.
Signature of Owner/ essee/Contractor as Agent f or Owner Signature of Contractor/License Halder
STATE OF FLORIDA( STATE OF FLORIDA
-e C yZ L
COUNTY OF U �L u l t' COUNTY OF
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
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this,2? day of e bVO- y 20 1b bar this 27 day of by 0.I' �J 20 by
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�u C i<1 Fi III mC)Y1 S' &t IZ I-1 j J <J
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(Name of person acknowledging) (Name of person acknowledging) {
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,ice/C.-Y� � � ° � ✓� �-C•l�G'G�c� �.�/
of Nota Public -Stat of Florid -0(
(Signature of Notary Public- State of FI a) (Signature ry I
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced _ Type of Identification Produced
Commission No. lTt G7 0:U Yb ' CHRISTINE 0MInlission No. t9t `� oC 5�1 tom^ pw; ?- • ' •..: s
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* * 'COMMISSIONS G052515
wr EXPIRES:Aprt ,2021---- t1S��.•: —QIIR
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Revised 07/15I2014 * * My COMMISSION#GG05M
'"� \oma EXPIRES: Apd 4, 2MI
REVIEWS FRONT ZONING SUPERVISOR i PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS '1
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