HomeMy WebLinkAboutBuilding Permit Application nq
ALL APPLICABLE INFO MUST BE COI ; ,�40�J�TION TO BE-ACCEPTED 'St. Lucie County
Date: _ Permit Nurfler
..�. MAR 2 2 201r
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PERdiITTING Date:
W - St Lu ieCounty. _ �.
guiding Oernt I&6CI L I W
Planning and Development Services AFFORDABLE A
and Code Regulation Division WORKFORCE HO SING
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial IResidential _
PERMIT APPLICATION FOR: -----_-----__-----_--- —�-
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PROPOSE-- �JD lM1ROVEMENT LOCATION:
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Address: / i:. .. up �)i 3 e- L ! o A z ` (- e !q:--L L!LI
Legal Description:_ a 1
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Property Tax I#:. 9-ice �?D _L" Lot No.
42 ,-
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Site Plan Name: I Block No.�2_
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Project Name: L ---
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Setbacks Front Back: Right Side: Left Side:
DETAIL p DESC R�PTION 0F:WORK
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CON:STRtJ:CTION.INFQRMATION
Additional'worK to,!!GasTank
orme un ert !s permit-c ec a app y:
OHVAC ❑Gas Piping _Shutters a WILows/Doors
Electric L�1 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: __ S .Ft.of First Floor:I
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Cost of Construction:$ ' c`� l 0�_ Utilities: Sewer Septic Building Height::
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O1NN ER/LESSEE; `CONTRACTOR
Name
I I s`11 ► i if19 21 h��`? Name:O� "Q \ �`l c� 1�1•�� _
Address: Company: e
City: \�1.� � P� Stater Address: � A��'�.rr P,�..(�
Zip Co le: Fax: City: State:
Phone No. B:)r-Zl�/t (, Zip Code:
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E-Mail: Phone No, y
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Fill in fee simple Tiitle Holder on next page if different E-Mail:"P (C nP
from the Owner listed abode) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
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SU'P .LEil/I1;NTA IJ�('IQN LLEh1 iAV1/ INFORMATION:;
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not A . licable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: _Phone: Zip: Phone:
FEE SIMPLE TITLE:BOLDER: _ _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: — Address: j
City: City: I
Zip: _Phone: Zip: Phone: I
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, I do hereby agree that I will,in alI 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 Idditions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another neon-residential use
WARNING TO CIVV NER:Your failure to Record a Notice of Commencement may result in your paying tivice 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
com encing work or recording your Notice of Commencement.
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Signatu of owner/I.ess Con r as Agent for Owner Signa of Contract Lic€pse=y der
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STATE OF FLORIVA I STATE OF FLORIDA! _
COUNTY'OFl L) COUNTY OF.--
The forging instrument was acknowledged before me The forgoing instrument was acknowledged before me
thia42day of t_ 20 Eby this day of 20 by
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{Name of person acknowledging} (i�Tame of person�cknowiedging}
( i
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ignature of'Notary Pu c- t5 ate of Florida ) Signature of Notary Public- ate of Florida)
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Personally Known Oft Produced identification Personally Known OR Produced identification
Type of identification Produced Type of Identificaff Pr uc
,,,y _ v MA 6E LA,' LUZ VELASCO
Commission _ MA DE �LA LUZ �SCO Commission No -. ._
MY COMMISSION#GG050399 �MMISSIOt� D5o399
EXPIRES November 28.2020
•',. E8 Novem ,
R.
Revised 0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -------------_-_— - _.
COMPLETE
INITIALS
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