HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1164
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Date: — Permit Number:
APR 12 '2Di7
Building Permit Application PER.MITTlING
Planning and Development Services St.Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED-iiMPROVEMENT LOCATIC+N
Address:
Legal Description: -?e—
. -ry
Property Tax ID#: o "cX� Lot No.
Site Plan Name: Block No.�/
Project Name:
Setbacks Fro t Back: Right Side: Left Side:
DETAILED D,ESCRIP .(16'INY5F WORK _
EtSTRUCTIQN,INFORMATILQN
Additional work to OGasTank
orme under this permit-check a apply: r
0HVAC ❑Gas Piping _Shutters Windows oors
ric 0 Plumbing �S nklers Generator oof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor: !L ;=
truction:$ � Utilities: _Sewer LJ Septic Buil ing Height:
OWNER/: SSEE `, CQNTRAC
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a e Name: kLVY, 4WA13 L
Address- Company: 6r
City: Stat _ Address:
Zip Code: Fax: City: /r State:
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Phone No _ n� Zip Code: F/ax:
E-Mail: Phone No. C <'
Fill in fee simple Ti Hold on next r p p ge(if different E-Mail: e O
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCTION LIEN LAW'.INFORMATION: :- -
DESIGNER/ENGINEER: Y _N pplicable J ORTGAG)7-WMPANY: Not Applicable
Name: /� r ame:
A ss: Address: %
C ty: Stat Cir tate:
Zi Phone: _ _ gip: Phone-
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FEE SIMPLE TITLE O-LpER: _Not Applicable BONDING COMPANY: Not Applicable
Name: �� Name:
Address: k 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 financingcensukt with I nder or an attorney before
commencingwork or recordingour Notice of Comm e ment.
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Signature of Owner/Lesse tractor as Agent for Ow :!!natu o ractor/License Holder
STATE OF FLORIDA STATE OF FLORI
COUNTY OF ST emu-c-/2� COUNTY OF �.L„kAtP.
The forKing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this 10 day of r ( 20 I1 by this L day of 20 by
(Name of person ackM ledging) (Name of person acknowledging)
i
(Signature of Notary Public-State f6f Florida) (Signature of Notary Public-State of Florida)
Personally Known 4— OR Produced dentification Personally Known OR Produced Identification
Type of Identification Produced /1 0�. Type of Identification Produced
DEB
Commission No.� y' I I{�� ORAH S.VEG
1r I) Comm sion No. I S. NIELSEN
+� MY COMMISSION#GG 09206 ;a °�
f� EXPIRES: =Q `y Commission# FF 1115637
�?•� October4, 020 = sions
Revised 07/15/2014 June 12, 2016
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE 5 I�11
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INITIALS
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