HomeMy WebLinkAboutBuilding Permit Application ALI;APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application a
Planning and Development Services c,
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ASE
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: Q(,Co S 50-2
Legal Description: F('everc"5s C600tcscn,rNto ,, i.J tk*
Property Tax lD#: Q50c) _(4Z10_(Z)03q_0()0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be nertormed under this permit-check all ttiat apply: Fi
11HVAC Gas Tank F]Gas Piping 1-1Shutters Windows/Doors
11 Electric Plumbing liSprinklers EiGenerator Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ex' Utilities:F]SewerF-]Septic Building Height:
Name c
Name: 3E_,,kryi c; X;,1_� iCk-U S4
Address:Ot(a OC_') S- c- Qr;,_t_ fsa Company:!,. f_4_(,�
City:A e_(%15 C,CN elo cam. State: Address: i,?,A U 9 i+l C,
Zip Code:3 Lvz,S Fax: city: I : i_17-� State:_1E:1_
Phone No. 79 a 9..19 Zip Code:-3'SL4 I Fax: 5-41
E-Mail: Phone No. 5-(-!
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 0 63 C,C)t7L 3 V
If value of construction is$2500 or more;a RECORDED Notice of Commencement is required.
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�SP El�ENTAL;Coh.'S.RbCA-, N L}EN LAIN }RlFORMAT}ON � �
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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 Applic i ble
Name: Name:
Address: Address: I
City: City: {
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count 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,l 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 I
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 recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent nna ure o ontractor/License Holder
STATE OF FLORIDA STATE OF FLO ,�
COUNTY OF COUNTY OF
The f Instr nt acknowled e Aefore me The forgoing instr ent was acknowledg before me
thi ay of 20]by this day of�"—"' 20 by
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( am of person acknowled '. ) (Name of person acknowledging)
(Sig t of Nota -State of F ri ) (Signatur of Nota Puubb =!��f Florida)
Personally Known OR Produced Id ntification Personally Known V OR Produced Identification
e y o
Type of Identification Produced_ Type of Identification Produced
�►gV PUQ USHER L.GRQGG
Commission �f3�Q'Y..,' o Commission�No. (Seal)
� � _ k(1i5e01�MISSION#GG 080413
* a°� ,�8rn ANGELAYOUNG
EXPIRES:March 7,2021
�rF fl� sorided Thru'040t Notary Sam= r MY CONUSSION O FF 351069
o` EXPIRES:April 12,2020
Revised 02/1512024 7jF®FFkd\ 6ontioThmbudget Notary Semme
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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