HomeMy WebLinkAboutBuilding Permit Application ,i'PLIC.AIf3LE INFO MUST HE COMPLETED FOR APPLICATION'TO SE ACCEPTED
Date: Permit Number:
Building Permit-Applicatidn
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft.34-9,9Y V//
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax lD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:, ^Right Side: Left Side:
� � lz�� �l►��. 3-5— C.'�R n..sC.
Wt�ona work to a pe orme under this permit-check a a appy:
Mechanical _Gas Tank —Gas Piping Shutters windows/Doors
Electric Plumbing Sprinklers _Generator T Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: —Suer _Septic Building Height:
Name A'eh l Name: Curd l5 _ ScLun yrt on
Address: So �"Q r z` �,c¢ar d v 0 Company:' 4 i r
City: State: ! Address: tie 15 S N i I r, Dr
Zip Code: r Fax: City: Pour 5'r Lkc1e: State; FL.
Phone No. J4,5--OW.-eIV41 _ - .__ ._.........- - - Zip Cade._ - q + . - - Fax,_.'77;_..,3.35. 14.6 4
E-Mail: Phone No. 77,E �,5 -3aLl
Fill in fee simple Title Holder on next page(if different E-Mail: Cu Sfica it -e,!4 m C0 1
from the Owner listed above) State or County License: CAC 05 1 R IO - 54ak2
If value of construction iS2.5Wor more,a RECORDED Notice of Commencement is required.
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OESIGNER/ENGINEER: Not Applicable Nit3RTGAGE COMPANY. Not Applicable
Nat4te• Name:
• .
Address:
- - —. Address: �� •
y State: may'
tate
Phond:
dip:• —. Phone: ip; � . •
FE IMPLY T[Ti.1E HOLDER: _Not Applicable QNb[NG C:CJ1V PAMr. _Not Applicable
Name Name:
Address: Address'
City: Phone: Zip. Phone:
OWNER/eoNT'RAGTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work orinstaiiation bas commenced prior to the issuance of a permit.
5t.Luciefou makes no riipresentation that is granting a permit will authorize the permit holder to build the subject structure
which is in Acct with m pplicable Nome Owners Assocration rules,bylaws or and covenants that may,restrict or prohibit such
structure..Please consult your Horne 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 Build'qpg Codes and St.Lucie County Amendments.
The following building permit applications are exempt from 0dergoing 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 lWh ire 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 financin& consult with lender or an attorney before
commenci ng work or recording our Notice of Commencement.
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Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY t)l= T l—V C I e COUNTY OF 6—
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The forgoing instrument,arcs acknowledged before me The forgoing instrur»ent vires acknowledged before me
this day of .20 Z.� by this.,PLrday of 2 , by
,�.._. �..�..�..._ter- ..�_� ...�—
(Name of person acknowledging) (Name of person acknowledging)
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(signature of Notary Public Stawof Florida) (Signature of Notary Public State rida)
Personally Known OR Produced identification Personally Known OR Produced identification ____
Type of identification Produced �AOL e wWwa FtrJW Type of Identification Produr d '
a ,r ■11
Commission No. Es q ��
* %Q E(pIM:A1d4.20J7 Commission N0. � •Z� * ~��
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REVIEWS FRONT ZONING, SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DA'Z'E
COMPLETED "}
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