HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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0 /S Permit Number: ' 01
111111
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 X_
PERMIT APPLICATION FOR:
PRCIPOSD tNPR'OVEIV_I' NTLOCATION ,. � , ' ; ,� k s
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Address: �" /' 1? V PSS P c /2 3 /�Z
Legal Description:
Property Tax ID#: Z i201 00 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK " �
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ONSTRUCTION INFORMATION
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Additional work to be pertormed under this permit—check all-that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
XElectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ /!��0 Utilities: _Sewer _Septic Building.-H�ighte:`j
Name kTM G Name: ! !i'. JI
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Address: I WO � �1r7tyctc� V Com an treq
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City: State:FL- Address:l_ S; ,� �a
Zip Code: 36 1 Fax: City: STG1Giyf State
Phone No. 310 -99/-- ifrfs,, Zip Code: 31-f 997 Fax:
E-Mail: M 14 6om Phone No 7 72 .3/ -077
Fill in fee simple Tit a Holder on next page(if different E-Mail `&` _5 7t7�yyle7L
from the Owner listed above) State or County License j!F1_ Dd02_o_3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CO<NSTRUCTION LIEN LAV1) INF�RMAT[ON Y
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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:
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 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 work or recording our Notice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLO � A / � STATE OF FLORIDA n
COUNTY OF / _� SL C��' COUNTY OF Lu
The forgoing instrument was cknowledged before me The fpr Ring instrument was acknowledged before me
th' ay of -, 201by this/- ay of 20, by
(Name of person acknowledging) (Name of person acknowledging)
(Signature ry.Public-State of Florida ) gnature of Notar ublic-State of Florida)
Personal) °•• c d Identification Personally Kn OR Produced Identifications,
Type of I i ;` N gar AN�F(q Type of Iden fico
Produce -.F yPdblie. MHUFf Produced
Y comm °n 'Ff p /florlda =
Commission No 80"ded�hr fXutreSMaY2 �®I) Commission:fVu n No q ' (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION%,,.1,',S 4F aANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v.7/2014