HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABL FIN(FO� UST BE COMPLETED iFOR APPLICATION TO BE ACCEPTED �f
Date: �`Y Permit Number: �i��� D / //):3
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Application MAR 2 7 palg
Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATI(bN:
Address:
Legal Description: (,r)hl4 Cl+-q OJ a(O `Ty , I it,04-F-r
C Lc>+ eI Ca.4� yr e��- � 40-7S
Property Tax ID #:,3�� — eL,� � i CD 44- Lot No.
Site Plan Name: �2 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED'DESCRI,PTION bF WORK:,`
I� l cP I l eI LJJ C 1 �'1 ►�- S
I ( ne 4-6 -IE56? 2-1 1
CONSTRUCTION INF'ORMATIO'N:
1'
AdditionalworKtobenerformedunder tis.permit-check
1]HVAC
all
apply:
Shutters
OW
Gas Tank
Gas Piping
_
nclows/Doors
Electric ElPlumbing
i Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
of First Floor:
S In
.Cost of Construction: $
i Utilities._
i
Sewer
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
�--� IQ�h �e�l��'1•.-1
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�
Name: �
,.
I:..•. .
Address:`{-�C�c—> ,:J-0f�_".
Company.
City: 9�I
Stat�
I;. —Lcxt� A
Address:
City: i State:
Zip Code: Fay
hone N . ��
Zip Code: x 7�
Phone i0.���-.;1 i
E-Mail: (�
I'
I'1�Q I
Fill in ee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail.
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTIONIIEN LAW INFORMATION: =
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address: '
City: State: !
City: State:
Zip: Phone.
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: I Zip: Phone:
I
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 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 concurrencyreview: 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 Of recording our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Aignature of Contractor/License
STATE OF FLO rn/ �
'Q I �JIM�`
STATE OF FLORIDA�COUNTY
Lta"
OF
COUNTY OF
ing instrument ac dged me
Th&—day
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The. r o'n i m pue t ac j � 2dged b e me
thisa�j Hof
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Name of pers aking statement
Personally Known OR Produced Identification
Name of persqWaking statement
Personally Known OR Produced Identification
Type of Identification nn '' ' `,, I
Produced I ��LS�nat �� L�
Type of Ident^ifica-ton
Produced '7JCf�S�I��� (�
-A,
(Sign ture o\`�jdti 11Mr4i���tate of Florida)
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ig to a of Notary\R�IdIiN11 44kh��Af Florida )
E C`O ��'�i
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` c�t�MisigN �, (Seal) I
Commis��
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Commission No.�`� �4,• •MMISS/qN., 9�''i� (Seal)
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�� �QTARY
NOTq�y
REVIEWS
PUBLIC
FRON�.��
ZONING
SUPERVISOR
FusiIC
PLANS.- VE_E S TURTLE MANGROVE
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REVIEW
REVIEW
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REVIEW REGGl. Fall/REVIEW
DATE
RECEIVED
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DATE
COMPLETED
Rev. 8/2/17