HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n 0� •
Date: l ' ' •ii( Permit Number: 1O O. O, l •
F L C? R I D R RF .
"_, Building Permit Application 4PR ` o .
Planning and Development Services 2
Building and Code Regulation Division pes�ttin 1818 I
2300 Virginia Avenue,Fort Pierce FL 34982 •
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �0U eot
PERMIT APPLICATION FOR:
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PR®P®SED°IN/�i PR®VEM/ENT LOCATI®Np: & i', '-,:.'".:.!:-:,:. .°°.. .1 ;a
Address: U �/ O l -)A i i l eJ` �'
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Legal Description:
Property Tax ID#: 311 -. '7o3 ' 0.3 ' a 00 ' ,S7 Lot No. •
Site Plan Name: • Block No.
Project Name:
• Setbacks Front Back: . Right Side: Left Side:
DETAILED DESCRlPTI®N� W®RKY ,a . p ,r; R/. ..
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..C® STR<UCTI;CIN,IN1P®RMATIO'Nna ., ,. ;. .4. b
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Additional work to be performed under this permit–check all that apply:
Mechanical . _Gas Tank _Gas Piping _Shutters. Windows/DoorsiJ
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Electric —Plumbing •• _Sprinklers —Generator _Roof Pitch
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Total Sq. Ft of Construction: • Sq. Ft. of First Floor:
e..,.,Cost of Construction: $ ?, E.-DOE.-DOUtilities: _Sewer _Septic Building Height:
•®INNER/LE:SSEE� ' • : f : . . .CONTRACTOR + . .. l',•%
Name kA~ -)1 Jq -'-'iS�Di1 Name: tb4-►Jc ... Sp•—,,7� ��
Addre: IC J Goll J jkrl'f Ci,-- Company: C C.: 0:(7 s9f,1 ��i?Gt',?�J�rc-S
City.: UO/. .f4- LuGiC cL State: EC Addre s: .lj" ul.0"rdyivieicr--,r Ldv
Y l`o S
Zip Code: Fax: City: 1-o r- S-A-- State:'G
Phone No. 777,2. F79 r- 1191 • Zip Code: 3�(c s`�2 - Fax:
E-Mail: Phone No 77) 7$2J Caefl,
• Fill in fee simple Title Holder on next page(if different E-Mail U/1C.LI4 /1 CDU I; n r ` (tea;/.ec 4–,
from the Owner listed above) State or County Licenses /�9c/cf 74/e? •
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA►L4CONS ilitiJCTION LIEN LAIN I'N�F®RMATi®. ,' ,r a : m 4
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DESIGNER/ENGINEER: Not Applicable 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: .
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 you intend to obtain financing, consult with lender or an attorney before
commencing work or recordin our Notice,pf Commencement.
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Sign of Owner/Le ee/Contractor as Agent tor Owner ignatur ntrac or/LLic ne se Holder
STATE OF FLORIDA�J C/��G � STATE OF FLORI AA 6„,,,,COUNTY OF �f� !! COUNTY OF
Th- , :.' g instrument w fs acknowledge afore me The foo' g instrum n was cknowledged before me -,
this., day of 20'1 by this day of I , 20 / y
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. �VSJi1'r G� d�° yi.74.44...„
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(/ v of person acknowledging) ( -of person acknowledging)
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S' nr3ture of Notary Public St e of—Florida) (Signature of Notary Public-State of Florida ) .
Personally Known OR Produced Identification Personally Known .OR Produced Identification
Type of Identification Type of Identification
Produceal, SS3o .1 18 .r17.f(p .,-o..,: - Produced
LASTAI•iviA 1NGH—'•'•
"!;'P���, State of Fk
Commission No. .ra--�e'.,(SpgI),y Public ,Commission No. (Seal)
49* ,gym- S.mu Comm.Expires De177 ;_
.: iii'. .e r,mmission# FF
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°:;;of --/ Bonded through NaUDIld a. •,{ I� �i
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• REVIEWS FRONT _ �S'IVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER EVIEW REVIEW REVIEW REVIEW REVIEW REVIEW •
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014