HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFOQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Company:,
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Planning and Development Services
Building and Code Regulation Division
Fort Pierce FL 34982
2-300 Virginia Avenue,
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
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PERMI I APPUC;A I ION FOR: To Select from dropbox, click arrow at the end of line
35 -3232E
7`11 335`32 -32-
PROPOSED IMPRUVEMt_N I LOCAI ION: _.
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Address: _ �f �S _!/_J ow n P ow (f
Legal Description:
Property Tax ID #: ^� yc3 -1 "' �U a b Q� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE IAIL)_U UESC;RIP l ION OF WORK: .
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CONSTRUCTION INFORMATION:
AdditonalworKtooeqertormed under this permit -check a app :
[]Gas Piping ❑.Windows/Doors
L_JHVAC Gas Tank _Shutters
OElectric Plumbing Sprinklers 11 Generator t] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
11
Cost of Construction: $ ��S b d _ Utilities: SeweE Septic Building Height
IOWNER/LESSEE:
CONTRACTOR:
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Name . I V? n i (' t 12emeur�
Address: W GZ.V,Q Q�
City: i n r-�- f'Cr _—_ State: -ELI
Zip Code: c�'1 Fax:�
Phone No. %� o� " �lO f t . 3s
E -Mail:
Rif in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
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Company:,
&,5 TGrvt A %r Ssi ems n c,
Address:
14 15 S 6 1/o I 1 da -, r ee t-� Q
City: FV R -t' 9t, L u cc c- State: r-�--
Zip Code:
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Phone No.
35 -3232E
7`11 335`32 -32-
-Mail:
E -Mail:
C Lt S t i r S£a c, i C c• vrt
State or County License: C O 519 ( 0
a required.
if value of construction is $2500 or more, a RECORDED Notice of Commencement .
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SUPPLEM EN I AL (TUNS I RUC: I IUN LIEN LAW I NFURMA I IU N:
DESIGNER/ENGINEER: — Not Applicable
' MORTGAGE COMPANY: _ Not Applicable j
Name:
Name: i
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
BONDING COMPANY: _Not Applicable
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Name: i
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 vihsch 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 accordarle v_.=ith the approved pians, the Florida Building Codes and St. Lucie County Amendments,
Thefolio•k'ing building permit applications are e.xerrptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, ..,a`ts, signs, screen rooms and accessen' uses to another non-residential use
WARN ING 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 recording your Notice of Commencement.
Signature of Ovmer/ essee;`Centractor as Agent f or Outerj Signature of Contrac-or/License Holder I
.
STATE OF FLORIDAj STATE OF FLORIDA r
COUNTY
OF �} ,� v (' j I COUNTY OF
The forgoing instru r:t :vas acknovdedged before me The forgoing instrument wasacknowledgedbefore me
this day of QrCh 20 J�by j tlZis � day of J��f'e l� 20 % �i by
eut-LIS Rmino iS' t`ctf� _I S11011,110n S
(Name of person acknowledging } � (Name of person acknowledging)
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(Signature of Notary Public- State of R, 'da ! (Signature of Notary Public- Stat of Flo
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced _ Type of Identification Produced
Sim Puo� CHRrrit-r
Commission No- i iii G'J 71 rq gaP,°4 CHRISME8Et�Qtj iill ission No. �1 t,, =
MY CGMMISSION # FG 0$2W
EXPIRES: April 4.2021 C p e :9
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Re-vised 07/15/2014 * _ * MY COMMISSION / GG ouw
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EXPIRES: Avil 4,2021
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REVIEWS FRONT ZONING SUPERVISOR t PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW l
DATE
COMPLETE
INITIALS
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