HomeMy WebLinkAboutBuilding Permit Application .PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
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Date:_ Permit Number:
REC.EIVED.AUG 042015
Planning and Development services wilding' Permit Application
Building and Code Ftegulption Division
2300 Virginia Avenue,Fort Pierce FL 34982'
Phone.,(772)462-1553 Fax: (772)462--1578 Commercial Residential
PERMIT APPLICATION FOR: V
Address: $fv J-it e>rf7 e[ eL L ,'12-
Legal
2Legal Description:
Property Tax ID#: Jq - 70 - 6P'�' - 000 - `7 Lot No.
Site Pian Name: Block No,
Project Name:
Setbacks Front Back: Right Side; Left Side:
ona wor a e pe Orme un er this perms -chock all thatappy:
—Mechanical —Gas Tank �Gas Piping `Shutters _Windows/Doors
Electric Plumbing Sprinklers -„_Generator Roof
Total Sq. Ft of Construction: Sq.Ft,of First Floor:
Cost of Construction:$_ �� � ^� Utilities: Sewer Septic Building Height:
Name: Curtcs 5a.mmon Z
Address: -ill�z Company: C,u5 TO M Air Su S fe.&1S_ _ &C_
City:���r!'S c State: U Address:
Zip Code: 34195-2- Fax: City:, ou 5T 1-kc if_ rJ State: rL.
Phone No. Zip Cade: , 45_52) Fax: q7,2 31') i U Sc
.E-Mail• Phone No. 772 33,5 -39.31
Fill in fee simple Title Holder on next page(if different E-Mail: cto 1 "M
frorn the Owner listed above) State or County License: CR C o S 191 D - 5 e
`"If'value of wristrue ion isZS80'or more,a RECORDED Notice of Commencement is required.
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DESIGNE ENGINEER: _•Not App:lica aro
RTGAGE COMPANY: Not Applicable
Name,• me•
Address: Address:�..-...'"., - � � �.� Stat'
City: State City: •._.w..,.
Zip: phone: Zip: Phond:
FEE SIMPLE TITLE"OLDER: Not Applicable BONDING COMPANY: „_,'.,Not Applicable
Name:, Name:
Address: Address:
City: City: --- _
Zi Phone: Zip: Phone,-_
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OWNER/CONTRAC"tOR 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 iii authorize the permit holder to build the subject structure
which is in gonfllct with any applicable Nome Owners Association rules+bylaws r a covenants that may restrict or prohibit such
structure.Please consult with your Home owners Association and review you rr 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 Plorida BulldIVI 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 Retard a Notice of Commencement may result in your paying twine for
improvements to your property.A Notice of Commencement must be recorded and pasted on the jobslte
before the first inspection, if you intend to obtain financing,consult with lender or an attorney before
commencing work or recordinix vour Notice of Commencement.
Signature of Owner/Agent/Lessee a Signature of Contractor/T1cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF T Lr V C Ie WUNTY OF. L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this__ day of .2Q_,,,,,,, by this ,,,�•day of •20_ by
Dur f iC 3�4)nYAor1s; T-rs n Wriaart 4
(Mame of person acknowiedging (Name of person acknowledging)
(S-ignature of Notary Pubiic4 Ste of Florida) (Signature of Notary Public-State o rida)
Personally Known OR Produced Identification Personally Ktaown OR Produced Identification
'type of Identification Producei .,Xy pwtea—EW MR Type of identification Produced
Gammission No. S O��9 + 1) EXpIRE5:Apfilt,20i1 Commission No.
`:k7,q°dlh�t[iu0p�t 7 EXPIRES*.AP 4.2DI
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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