HomeMy WebLinkAboutBuidling PemitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i � i
Permit Number:
S . '�! 41 .y roG M1 y0..
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Building Permit Application
Planning acrd Lievelopment Services
Building and Corte Regulation DIvIslon
2300 Vlrglnta Avenue, Fort Pierce FL 34982
Phone: (772) 462-1555 Fax: (772) 462-1578
Commerdal Residential
PERMIT APPLICATION FOR; To Select from dropbox, click here
PROPQSED'INPRbVEM�ENT`LOCATION,'`
Address:
Legal Description;
Property Tax ID #::
V-1 V
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Site Plan Name; Lot No. —
Block No.
Project Name
Setbacks Front,_,_, Back: Right Side: Left Side:
DETAILEDP1ASCR1PTION OF WORK;LA 6
v
a
CONSTfZUC.TIaN IN {]RMATION
bona wor o e erforme un ert s perm —c ec a aPp Y ,.
HVAC Gas Tank Gas Piping
Shutters � Windows/Doors
I®IElectric IL Plumbing Sprinklers GeneratorEl
Total Sq. Ft of Construction; Roof
S Ft, of First Floor:
Cast of Construction: $ j t � . `� lftilitles:� Sewer Lel Septic Building Height:
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OWNER%LESSEE; __
Nam
rnuui�ss: ld{?-J1 Gi�.cf. M lti+f
City:
State:
21p Code State:
Phone No.
E -Mail: y
Fill in fee slrr!ple Title Holder on next page ( If different
from the Owner listed above)
If value of constructiorl Is $2500 or more, a
Name:_L_)Qrel A,1 (&4 b- A
Company: tilr��zr/f Nil
Address: ,SGL AI��City: 7),94 ',57 Lc tc. �Zip Code:-3'�`�d"' Fax: 7'7
Phone No. %7,2?- .ta.3
E -Mail. (SC(ALt_M NVYA'C a �-
State or County license: (CC
ltfatice of Commencement 1s requlred.
Name:
Address: State:
City:
ZIP: Phone:
PEE SIMPLE TITLE HOLDER: _ Not Applicable
Name,
Address:
City:
Zip: Phone-..---
MORTGAGE
hone:
MORTGAGE COMPANY:
Not Applicable
Name:
SUPERVISOR
Address:
State:
City: .
MANGROVE
Zip: _____.,__._ Phone:
COUNTER
BONDING COMPANY:
Not Applicable
Name:
REVIEW
Address:
REVIEW
City:
Zip-. Phone`
I certify that no worm or installation has commenced prior to the issuance of & permit.
S Lucie County malt no represej�e"Horomtha"Olwsnaers ranting a permit will authorize the permit holder to build the subject sCructii�re
w ick Is in con nil wit any appl1 Association rules, bylaws ora covenants that may restrictor prohibitsuch
structurePleasec wl ', with youme Owners Association and review your deet for any restrlations whsch may apply:.
In consideration of the granting of this requested permit, l do hereby agree that I will, In ail 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 addltions,
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 jpbsite
before first Inspection. If you intend to obtain financing, corse a "az attorney before
Slratare s�f:0wnerf Lessi~e/Agent ; L,
STATE OF FLO_R_IIA
COUNTY OF.!,
The for Ing instr m nt was acknowledged before .9 a A
this day of l . '20 ,�,_` -by f ii
V
,C`\ ` r 1� i1 _ A _ c:3 is
person
'(Signature of {Votary Public State of Florida }
Personally Known k�OR Produced Identification
Type of Identification Produced
Commission No.L "'" (Seel)
Revised 07/15/2014
STATE OF FLOR ±� 2A3
COUNTY OF
The for instrument was acknowledge'dCbefore m i
this I""day of �'� Zo i 1 by14
�_ _____ r 4. A __ 015 mi
(Name of pArson acknowledging
of NWtary Public- State of Florida )
Personally Known i! OR Produced identification
Type of Identification Produced,
Commission No. `� � (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS