HomeMy WebLinkAboutBuilding Permit Application .,PPLICABLE INFO MUST BE COmi-LETED FOR APPLICATIONTO BE ACCEPTE.-
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Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce PL 3498f
P (772)462-1553 Fax:(772)462-1578 Commercial Residential
Phone:
' PERMIT APRLICA71ON FOR:
Address., -pea
Legal Description:
Property Tax{II#- .1 -4�
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
9Itiona Work to-b-e perWmed under this permit-check all that apply:
7mechanical —Gas Tank Gas Piping Shutters Windows/Doors
—Electric —Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
Nam
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cil Lila State:,Ft, Address t� 15 S S V (a r-pe&- Dr -
Zip Code: d Iti
4q;�. Fax. City:-&-T ST LACy - State:f
Phone No. Zip Code: 34 Fax: 77,;, 335 6,�
r OaL, Phone No.
14 3,5"
Fill in fee simple Title Holder on next page(if different E-Mail: C-ILS-to-ir g,, q, ca,Lrm-
from the Owner listed above) State or County License, CAQ?5IR/0 S
If value bf construction IsZsWor more,a RECORDED Notice of Commencement is required.
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DESIGNERJENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: i State: City: tate:
Zip: Phone: Zip. Phonal:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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 prier to the issuance of a permit..
St.Lucie Count+rr 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 respedts,perform the work
in accordance with the approved plans,the Florida Buildipg 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 failtrt'e 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
commencin work or recording our Notice of Commencement. f
signature of Owner/Agent/Lessee Signature of Contractor /cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S T L-V C i e COUNTY OF-,L,—
The
F;The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .20_, by tjris ,T day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public Sta of Florida) (Signature of Notary Public-State of ri a
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced ,ar 24mall Type of Identification Produced
�y MYCOMMiS810NtEE659 �°�;:YP&&11
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Commission No. B * 11) EXPIRES*April 4,2017 Commission No. � ',5'/do°� * MyC081M13810MIFE109
�?�or donooath�0uaa�te�sYs
EXPIRES:April 4.201
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.-772014
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