HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDtAf
Date: Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services FEB 13 2017
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 gt. Lu County, FIL
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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PROPOSED IMPROVENIENT',LOCATION:
Address: 50 5 & q !fErl r-4' PI erC2, F- L— 3`k
Legal Description: �7 m N f. CQY' &F &I UJ Y4 o F /v W
s a-!�U Fi T14 W ZJ 1 7-14 66 C t__ 1`_0 Fl- Fop I°o
Property Tax ID#: a I Qg -a a a 0 d 4 --0 00 - K Lot No.
Site Plan Name: NO- Block No.
Project Name: 01 Ct,
Setbacks Front Back: Right Side: Left Side:
:'DETAILED DESCRI,PTION,OF 1NORK
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,;CONSTRUCTION.IN'FORMATION
itiona work to be
ne Orme under this permit-check all appy:
HVAC LJ Gas Tank []Gas Piping _Shutters a Windows/Doors
Electric Plumbing O Sprinklers 11 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: O o Sq. Ft.of First Floor:
Cost of Construction:$ �� Utilities: 0 Sewer E]Septic Building Height:
OWNER/L'ESSEE CONTRACTOR:
Name__ t -16ui 1-i G COLI` Iraq ,s DDrfi' Name: 12o.n l`- a r!:1'_'1-- -sol-I 's -�-hc.
Address: 50.�) N 3c1+'h 5+ Company: " `( I k
City: F+ V i ct-Ce, State: rL Address: 10(4 5L1 Es-I-A.L&S h Ave,
Zip Code: 314 affb Fax: t 1j A- City: P+- 6F- (--uC'e State: FL
Phone No. -7'7a - 5 19 -017 a Zip Code: 344 53 Fax: (77-1) 8701- 1-710
E-Mail: n la Phone No._(77a� $7G - 1 -7 / 0
Fill in fee simple Title Holder on next page(if different E-Mail: ►r' �xcLrrq
from the Owner listed above) State or County License: C 6 C ()'59 _7 (0G
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. =J
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DESIGN ER/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: ZNot Applicable
Name: Name:
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 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
commencine work or recording your Notice of Commencement.
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Signature of Ow'neLessee/Contra r as Agent for Owner Tignature of Cot fado .Licen Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 24
tr COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1'2*day of_741)b 20�by this 13 day of 'FQ6 20 by
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(Name of person acknowledging)o (Name of person acknowledgio)
4bate of Florida
ig&ature of Notary Public-St9te of Florida '(5fignbiture of Notary Public-
OR Produced Identification Personally Known OR Produced Identification
Personally Known on—
Type of Identification Produced Type of Identification Produced
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEG AT °„
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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