HomeMy WebLinkAboutSUBMITTED PAPERSALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7
Date: (I. A.IS SCANNED Permit Number. 1��o d S33
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St. Lucia County RECEIVED
Building Permit Application JUN 2 9 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _1
PERMIT APPLICATION FOR: To Select from dropbox, click here III
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Fr
Back: . Right Side:
Left Side:
Lot No,
Block No.
HaamonaiworKcone errormea unaerimsperma-cnecKan appry:
0HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric Plumbing Sprinklers Flenerator Roof
Total Sq. Ft of Construction -.I S Ft. of First Floor:
Cost of Construction: $ 4L4� Utilities: Sewer Septic Building Height:
:OWNER/LESSEE ` - y
OONTRA
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Name
Name:
Address:
Company:
OF -eMf
City: State:,
Zip Code: I� �1,, �Fax: /
` Phone No. LEI- UIJ - Oq�L33 4
Address:kool S,ftyyeA
Rye&w.
City: a
Zip Code: _:RUAg%_
Phone No.-12, - LKPSA
State:
Fax:�]Z�i�1
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:O M(2 Y f
r i c'
W W'l I• Q�
State or County Licenser
(DLoL(
If value of construction is $2500 or more, a RECORDED Notice of Commeno tnent is required.
$UPPlEI1116NALCpNTJTI(�f1lf�151NFQR�NITCYId.*
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 Coun makes no representation that is granting a Hermit will authorize the permit holder to build the subject structure
which is in con ict with any applicable Home Owners Association rules, bylaws or ari 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
Sgrature of Owner/ Agent/ Lessee FUNTYOF
nature of Contractor/License Holder
STATE OF FLORI A /, - ATE OF FLORIQA q /
COUNTY OF (!Gf Cucl� �_J�ftrt
The forgoing instrument was acknowled ed before me The f_orrggo�ing instrument was acknowledged before me
thi day of �lirl� 20� by th sof l� day of I" 20-1&lby
�flrnuel T.uvhayllrncre/ %-c �)te-!
(Name of person acknowledging) (Name of person acknowledging)
Type of
Commission No.
Revised 07/15/2014
Personally Known v
Type of Identification
Commission No.
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
T LUpIEjCOtT, D
OR COW
ION
REVIEWED By d_ PJANCE.
DATE
ND R&IIT TBE
PLANS AAND PE mus RE OR NOM-SPECTI KEPT JOB
ON WILL BE MADE.
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