HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j� d
Date: 9,LoI1RECEI,• 7D SEP Permit Number:
3 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: To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCATION
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Address: .l, \ \\
Legal Description:. p \__
Property Tax ID#:_y �� v' ��(���(���7�—( (Z� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D:ESCRIPTIO4OF WORK
Wf� JMQSQm) (a-e-Dunu )
(�{ e Living &M) Cg owes)
CO,NSTRUCTIQN'INFORMATION.
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Additional work toe performed under this permit—check all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters �4i,ndows/Doors
Electric ElPlumbing ❑Sprinklers Generator Rof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ ol�,C���� Utilities:n Sewer❑Septic Building Height:
OUIINER/LESSE'E `CONTRACTOR: .
Name Name:
Address: �\QQ3, `C1\�� \� \(i(1�C7 Company:_� L�S`(x�
City: (Am C \V:\ State:VL Address: �AV P
Zip Code:—9+AClCID -par. P6 a(Ic1(\(Y1GS�, cit 4 , C-,\,-k State ii L.
Phone No.: 7A- Zip Code:34otqr,� Fax:
E-Mail: =j �P('� c����(��C> Phone No.C�h�
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
j '04�INFORMATION:' 6n,
SUPPLEMENTAL-C,ONSTR,UC",T,ION.�LIEN"LAW INFORMATION:'
ZINO
DESIGNER/ENGINEER: _�O Not Applicable MORTGAGE COMPANY: � of Applicable
Name: Name:
Address: Address:
City:. State: City: State:
Zip: - Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of 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 County 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
t 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-rk or recording your Notice of Commencement.
s
Srg—nYture- of Owner/Lessee/Agent Si nature of Contractor/License Holder
LORIDA FLORIDA,-7
STATE OF F
"COUNTY
OF
COLINTYOF
The f9igoing instru nt w acknowledged,before me The f ing instrument was acknowledged before me.
day of
_is,-2�_day of 20 Eby this20 by
ev V,:;)ql\l
nowledging
.(Name (Nam
(Signature of Notary Public tate of Florida) (Signature of Notary.
otary Publ!V-State of Florida
Personally Known L"' OR Produr-d Id, Personally Known OR Produced Identification
Type of Ident!$cp roduc%li;"RI KELLF-Y Type of Identification Produrpd
ED
ELL
NOS
T45
w
MY # E2250]05 SHERRI KELLEY
OiS E
Commission P 110 Commission No. on
c0mM1cJ§Pa_&EE225005
er 0 .
1,A9,11 October 2016
F I afi d a Nots N"YS 0�Nml We EXPIRES october 04.2016
(407)3g"i53
(40 )r3�.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS