HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s� Permit Number:
RECEIVED OCT 14.2015
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: hCG
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Address: 4170-7 Z`4
Legal Description:
Property Tax ID#: 01 04y a- Goo — Q Lot No. Z-17(9 7
Site Plan Name: Block No.
Project Name: Ff/1 C-P
Setbacks Front Back: Right Side: Left Side:
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CONTRUCTICN�INFORMATION r �� �*�
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Additional wor to be pertormed under this permit-checK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 7,5,90�� Utilities: —Sewer —Septic Building Height:
OW;NERfLESSEE ;
*d'd.. �J'a,=�s• , *-
Name u rl J ,r, .P0f- Name:
Address: (' Company:
City: f e State:_ Address:
Zip Code: _?� j .I Fax: City: State:
Phone No. 3�6 99 7 -5_q141 Zip Code: Fax:
E-Mail: QJ t)pj& •CD' Phone No
Fill in fee simple Title H 1 er on next pag (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.
StJ'11PLE11/IEN A>_C®NS1"RIJCTIQN LIEN I � '; E OR�I1/f/�TiON. 1101
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMP NY: _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: Phc ne:
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 the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and cove iants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for an 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 eview: 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 'est-i spection. If you intend to obtain financing, consult with lender or an attorney before
comm,eiTcing wo k or re in our ice of Commencement.
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Signat of Ow er/Lessee/A ent Signature of ContractorLicense Holder
ATE OF LORIDA STATE OF FLORIDA
COUNTY OF 5 C\ COUNTY OF
The f,grgoing instrument was acknowledge before me The forgoing instrumen was acknowledged before me
this day of 20 by this day of 20_ by
(Name of person acknowledge g) (Name of person ackno ledging)
(Signature of Notary Pub' -State of Florida ) (Signature of Notary Public-State of Florida)
\S �`I
Personally Known OR Pro>��
IiIi0&0 c�6 Personally Known OR Produced Identification
Type of Identification e6\ Type of Identification
Produced 1. L QOp�ce5��a5a �A�°' Produced
Ac My �S ���a� .
Commission No. t,L �( ��� Commission No. (Seal)
REVIEWS FRONT4j_,.& SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTE REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014