HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y Permit Number:
RECEIVED
Building Permit application MAY -19 2015
Planning and Development Services
Building and Code Regulation Division -
2300 Virginia Avenue,Fort Pierce FL 34982 ;
Phone: (772)462-1553 Fax: (772)462157$% �lddl Residential
PERMIT APPLICATION FOR:
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PONDER
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Address: 5!4
Legal Description: % Lknt�-
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Property Tax ID#: �� " �� t b�j0"l Lot No.-
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ivona wor to ape orme un er t is pe.rmit-cneck all tat appy:
Mechanical _Gas Tank _Gas Piping `Shutters _Windows/Doors
_Electric _Plumbing `Sprinklers `Generator _Roof
Total Sq. Ft of Construction: ►r Sq. Ft.of First Floor:
Cost of Construction:$ � , �n (� , Utilities: —Sewer —Septic Building Height:
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WNER/LESSEE• "t�, X,�ra- "�<,�u°xn'W c"'� fir' „tom '�f *.,i
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Name '' Vl� , C'l�Nil':�
Address: r V, A 0 \ Company:
City:. JQlV1 D State: Address:
Zip Code: Fax:_ t�lf far City: Stater
Phone No. 201 — Zip Code: Fax: �� -
E-Mail: Phone No. —
Fill in fee simple Title Holder on next page(if different E-Mail: '
from.the Owner listed above) State or County License: '
If value of construction.is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phon Zip: Phone;,
FEE SIMPLE TITLE HOLD R Rbt 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 prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize thepermit 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 Commen4be
y re your paying twice for
improvements to your property. A Notice of Commencement ued and ostedonthejobsite
before the first inspection. If you intend to obtain financini
onsnder or a attorney before
commencingwork or recordingour Notice of Commencent.
filgna ure of',•wnerJ.�Agent/'Le eek j Si of Contr icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �`rY: ��A C.-1 f� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of `M\ J 201 by this 1,4 day of MAV _ ,20 by
\J
(Name of person acknowledging) (Name of person acknowledging)
(Signat•(e of Notary Pub e o orida)--------' (Signature of Notary Publi��c State of Florida}
Personally Known _ Personally Known `'"� i uced IdopkfacW9M
""�»�! IIW BAKAIS Type of Identification P e •°
Type of Identification r�k� '-. Yp ic-_State-st-glad
��_ o a y r' z�� �Q; (kyr Commission Expires Jars 4,2418
Commission No. * $ ' My CoE>Epires Apr 13,2017 Commission No.!"FD 7 ',!, „� :' Cabin#FF 074781
Com 1 #FF 046231 —
%4 Bonded Through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014