HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �{
Date: .111-z/ /,)1,� Permit Number:
RECEIVED MAY 19'2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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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
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Address: `
Legal Description:
Property Tax ID#: - iLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwor to ;Ga-
orme under this permit-c ec a app y:
HVAC Tank ❑Gas Piping _Shutters Windows/Doors
Electric El
lumbing Sprinklers Generator 11 Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ;' , 1.^`t Utilities:0 Sewer Septic Building Height:
"L �Name :,r.'" f �' / �/ .Name: 0
Address: i Company:
City: ( jr,2 3�l �c, Stater Address: W va v
Zip Code: 5 f Fax: City: S'�'Vo r�- •Ly,-%4L State:T_\- '
Phone No. -2 7-2`1!1-2- 2L Zip Code: �`"°t tj Fax:-J" '2,—T 1-rOW601
E-Mail: Phone No. $ f
Fill in fee simple Title Holder on next page(if different E-Mailvw*+ {, 7'
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
E00/1001r3j XVd 02:TT 9T09/6T/90
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: 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: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count 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 record e `ai posted on the jobsite
before the first inspectipn. If you intend to obtain financing,c nsult with len i' {° n attorney before
commilpircing work or In Commencem
Si re of Owner/ ent essee Signature o Con rac t•/L nse Holder
STATE OF FLORIDA STATE OF FLORIDA t
COUNTY OF f`" -' 't,''e I`' COUNTY OF z
The forgging instrument}Y s acknowierlili before me The forgoing instrumept was acknowledeed before me
this F .day o€ /.1�#'* - 020J5-by this . ; day of °'-S'� «%"' ,a01J-T3y
(Name of person acknowledging) (Name of person acknowledging}
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{Sign of Notary Pu - Zd
lorida ) (Signatu Notary Public-S t'e Flo ' a,)
Personally Known _ eci Iden it1{3tjnn � Personally Known�_ R... .tXV.0fZffWAyA
Type of Identificatio P.rType of Identification Produced
MY COM ON#FF165172 EXPIRESPct ber 1,2016
Commission No. � Commission No. Wea
XPIRE October 1,2016 Florida otary ervico.com
ao7 99sotsa Fioridallota Service.com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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