HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOBE AaEPTED
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SCANNED
BY
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`iRECEIVED APR 1, 2015
_- St. Lucie a - RECEIVE®
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Permit Application
Planning and Development Services APR 9 2015
-
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: "'s '
Property Tax ID . Sb Z7� z 6 6 O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: ' LeftSide: 7 U
4,
DETAILED DESCRIPTION IFWORK:
CONSTRUCTION INFORMATION:
Additional worK to e e orme under ispermit —c ec a apply,
(3HVAC be[:]Gas,Piping ❑Windows/Doors
_Shutters .
Electric Plumbing []Sprinklers Generator 1:1Roof
Total Sq. Ft of Construction:CIC) '. S Ft. of First Floor:
Cost of Construction: $ ���� UtilitiesSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: /t%/9/eG A. F,6i65L% O
Address: 40
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Company:_.-CQA1ir-1rirT.4= P litS /:dC
City: - State:
Address:' . o2c/ �S'i/ 3cff.C- 3i
City: State:_����
Zip e: 3 Paz:
Phone No. 7— /
;Zip Coderzy 996-- -- Fax:
E-Mail: ��
Phone No..
Fill in fee limple Title Holder on next page (if afferent
;Mail: f=oiv Cm
State or County License: GG G
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN .LAVN INFORMATION;
DESIGNER/ENGINEER:
Name:
of Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Address: e)
Address:
City:
Zip: —7 0 Phone:'U7
State:
s3z7doo
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: 7ZotApplicable
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
commencing work or recording vour Notice cif Commencement:
_ Signature of Owner/ Lessee e t
STATE OF FLORIDA
COUNTY OF
The f oing instru nt was acknowledge b ore me
thisYdayofTl 20 4�by
Florida
Personally Known "t/ OR Produced Identification
Type of Identification Produced
Commission No.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF mowfio
The forgoing instrument was acknowledged before me
this $ day of a�r'� 20 L:�_by
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. r F 057191 (Seal)
r a= EXPIRES: January 2s, 2o1B VA. —
Revised MY COMMISSIONaFF057191
07/15/2014 �'••P,,,,t•` BondedThn,untaypuNi,ijdowaom y EXPIRES: January25,2011
Bonded nM Nouov Punk umc�m
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ZONING
SUPERVISOR
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MANGROVE
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INITIALS