HomeMy WebLinkAboutBuilding Permits All APPLICABLE INFO MUST BE COMPLET R APPLICATION TO BE ACCEPTED ��
Date: Permit Number:
E� , ..
Building Permit Application
Planning and Development Services JUL 2 4 ����
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ,/Y
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: ,P 'Az? CTT- )7f'
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Address: 71573 rcaLLO�/ �Lf3C l' �oht �C Lu�� F __— $` �
Legal Description: 1001- t
Property Tax ID#: 5-01— /60 $fDO Lot No.� _
Site Plan Name: Block No. _
Project Name:
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Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric Plumbing _Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: 5 7 6 • 0 U Sq. Ft. of First Floor:
Cost of Construction: ��� Utilities: —Sewer —Septic Building Height:
Cot $ ,�
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Name O/�/ i h Name:
Address: -719 3 GuLLDIftz ALICE Company:
City: /00/4 .S74 G 61C i 6' Stater L Address:
Zip Code: 3 q 9 5',Z— Fax: City: State:
Phone No. '7 7.2 — 3 76 — 5- 7S/ Zip Code: Fax:
E-Mail: /V14/VC�i Q �4 f't.. Al Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/FMGINFER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: k" Name:
Address: CC Address:
City: State: City: State:
Zip: -3oZ 72r) 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 thepermit 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 recording our Notice of Commencement.
Signature of Owner/Lesse ontractor as Agent for i I Signature of Contractor/License Holder
STATE OF FLORIDA �4 � i�
w V?`; STATE OF FLORIDA
COUNTY OF ' z U'` i COUNTY OF
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Thef r oing instru t was acknowledged before < x The forgoing instrument was acknowledged before me
this day of 20 1 'by zw this day of 20_ by
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(Name of person acknowledging) ` ''' (Name of person acknowledging)
aw6lZ14-
(Signature of Not, ry Public-State 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
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED J �
ev.
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ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
® FORT PIERCE,FL 34982-5652
a_ e 772-462-1553
FILLED LANDS AFFIDAVIT
I,the undersl ed am the owner of the fo g described property:
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(Tax ID/Legal description/Address) ¢'Lp-. --.-?� a
for which I have applied to St.Lucie County for a Final Development Permit. In accepting
this Final Development Permit,BP Number , I acknowledge that as owner of
the above described property,and in accordance with Section 7.04.01(D),St.Lucie County
Land Development Code, I shall be responsible for assuring adequate drainage so that the
immediate community WILL NOT be adversely affected. I further acknowledge that in
granting this permit for the development of this property,St.Lucie County is neither obliged
nor liable to provide for,or maintain in any form,adequate drainage off my property which
will not adversely affect the immediate community.
Property Owner Name Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED- V BEFORE ME THISy' DAY OF 20-1
BYa,g1s Ti e&)LLD WHO IS P N OWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
SIGNATURE O OTARY TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC TITLE COMMISSION NUMBER
&DREY&HUMPHREY
MY COMMISSION#FF 174772
EXPIRES:March 6,2019
Bonded Thru Notary Public Underwriters