HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I�1F qST BE OMPLETED FORIAPPLICATION TO BE ACCEPTED
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Date: Permit Number:
F.
11 111111 Ir
Building Permit Application
Planning and Development Services i
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 (�
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential i\
PERMIT APPLICATION FOR: \
Address:
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Legal Description: 0 3 1=r vwh
Property Tax ID#: f30 (o 5-0 1 `C) 7 ,-[w d `� Lot No.
Site Plan Name: fAd-f Block No. -70
Project Name:
Setbacks Front Back: �ight Side: Left Side:
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mono=-
bd
AaClitional work to be pertormed under t is pe mit-check all that appy:
_Mechanical _Gas Tank _has 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:
nom
Name_SLJ 9&, r Name: to r �a alr0
Address: tOS7 2 r ^e Company: w f r Pil- LL C
City: _ ae_ Stajte: Address: 0 -7 3
Zip Code: Fax: City: Y-I Cts h 9 0 State:--
Phone No.�g{9 ( 3 � to Zip Code: p Fax:
E-Mail: Phone No..� ,IC) 7-
Fill in fee simple Title Holder on next page ( if different � � ( ( 124 -2#3 --O
from the Owner listed above) State or 6euntyLicense: I S70 WY17
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If value of construction is 2500 or more,a RECORDED:Notice of Commencement is Aecluired.
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SUPPLEMENTAL: CONSTRUnbN'(.IEN I.AW INFORMATION:
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: j Name:
Address: I Address:
City: i City:
Zip: Phone: 1 ' 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 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 Alssociation 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 respect perform the work
in accordance with the approved plans,the Florida wilding Codes and St. Lucie County Amendm t .
The following building perm' plications are exeipt from undergoing a full concurrency revie : r m additions,
accessory structures,swi in pools, fen es,walls,signs,screen rooms and accessory use t ano er non-residential use
WARNING TO OWN R: y ur fai re t Record a Notice of Commencement may r suit' your paying twice for
improvements to y ur pr per . A N tice a;f Commencement must be rec r ed a d post n the jobsite
before the first ins ectio . I you int nd to pbtain financing, consult with I der o an a orn y before
commencin wor or rec din yo
Noticd of Commencement.
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Signature of Own /Agent/Lessee ' Signature of Contr for/License Holder
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STATE OF FL IDA STATE OF FLO DA
COUNTY OF ANGE COUNTY OFOR !GE
The fo Din i strum u t t w knowled e oreime The for Ding ins umept was nowledged re me
this day f �� e 20. � I�!' this day a �_=� 20—N by
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PETER A CAFARb 111 f PEJER A CAFAR0 III
(Name of person acknowl (Name of person acknowle ing 1
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( ignature f Notary Public-State of Florida ) (Si nature OP
Notary Public-State f Flor da I
Personally Known x OR Produced identification_ Personally Known x OR Produced identification
Type of Identification Produced _ Type of Identification Produced t���y}
Commission No. EE 174164 Y"y'ti^+ mmission No. EE 174164 nr� nip ��ott.ty'r ifcllic State of FlonO <
i Notary PuWiclState o!Flouda ? E, Kari M RiCCaboni i
Kari M RicC bgni y c M Commission EE 174164
y of F,oF Expues-05!26R016 ' ai no �Lxpi es 0586!2010
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW f,EVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS