HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SEP 11 .1015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: 6C0n)& AV
Legal Description: �t�3"j �tl�2 sr /,a>Z ar �- DF X/ GU 0� �� t055 Is AC_ i�
I,"5 oXA,-J&-E Ave r,-J P 1 z-_ -Ib 617 11, )
Property Tax ID#:- .2_7b9 ;3 7 I DDB 3 OFw I Lot No.
Site Plan Name: e S(i F-), Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: -
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Additional work to be performed uncler this permit-check all that appy:
_Mechanical Gas Tank. Gas Piping _Shutte'rSWindows/Doors
_Electric _Plumbing _Sprinklers =Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �7 �gdr-"� Utilities: —Sewer _Septic Building Height: f�
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Name 6/Fi26i mzuS Name: Si-/C-�U0J �F-O�.lbf,td,�
Address: Il 9gl Company:
City: ! GE-'zE State: Address: 37-71
Zip Code: .g9�fV_ Fax: City: !::I::- Pc 1,76� State: F:Z
Phone No. 772. q'71 p5-&7- Zip Code:,!;iJ17 7,- Fax: 722- q61 _61g3
E-Mail: Phone No 77) a-l 6 s6 f 7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License [�bSSc_7,3 Jul-6zE-11
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: �faYU11✓`/ e fr Name:
Address: LYL)j t,)2 Address:
City: F5 L_ State:f2 City: State:
Zip: 32(4fZ Phone 7YZ. 11L 5-529!� Zip: Phone:
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 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 l 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 recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing w reco , ing your Notice of Commencement.
Signature of Owner Lessee/Agent. Signature o ractor icen older ''
STATE OF FLORIDA - = STATE OF FLORIDA
COUNTY OF ? COUNTY OF'
Ir -�T U
The f r oing instrum nt was acknowledged befo The forgoing instru ent was acknowledged befor M� m
thisJJ day of 20by a"� this day of 2611—by "'�
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CO;bXVe,0,,Ph17 A A k/--J,4 Z C v O A G
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(Name of person acknowledging) o (Name of person acknowledging)
ON
(Signature of No , Pu/blic-State of Florida) (Signature of N t Public-St of FI ida MWOU-iZ)
Personally Known `1 OR Produced Identification Personally Known C.1� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. .(Seal) Commission No. (Seal). "
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014