HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFOMU ZBECMPLETED FOR APPLICATION TO BE ACCEPTED f
Date. Permit Number: l ��
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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 '/P
PERMIT APPLICATION FOR: nn
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Address: 1 � �5
Legal Description:
g Property Tax ID#: / -,206 -3 Lot No.
Site Plan Name: iS,�, �c �e/%Z_- Block No..
Project Name: sem,
Setbacks Front Back: Right Side: Left Side:
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itiona I work tobe performed under this pe mit-check a tat 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:$ 1:57)C1 Cel
Utilities: —Sewer. Septic. Building:-Height:
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Name SaSQA.111 v Name; cLma ey /I e,ag
Address: 1 Company: r?.P n t el" r
City: State:,a f Address: _33 of
Zip Code: 3 3v, ► Fax: City: 19-Bee4-1 State:/
Phone No. 7-7-2 G3'3 zr"7yG Zip Code: 3y4J06? Fax: 27L - 59r-
E-Mail: Phone No. ?.)07 -Co33 •v7yG
Fill in fee-simple Title Holder on next page(if different E-Mail: o'?,07.0p, of
from the Owner listed above) State or County License: S^7
i If value of construction is 2500 or more,a RECORDED Notice of Commencement 1s required.
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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:
1 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 the permit holder to build the subject structure
which is in conflict with any applicable Nome 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
im ov.�ments to yourproperty.A Notice of Commencement must be.recorded and posted on the jobsite
fore th`e fir ection. If you intend-to obtain finan ' ,c suit i lender or an attorney before
c menQ nl k r r din our Notice of Commen ment
Signatur of Agent/Lessee a ure o ntractor/License Holder
STATE O RIDA STATE FLORIDA
COUNTY OFT Lir�a COUNTY OF
The for oing instrument was,a cknowledged before me The for oing instrument was a knowledged before me
this 7 day of /Llan,',' Vl .20�by this�day of �ld�.ti 20 LC by
Lrl*r= �i .� - / Leij-e
Lat-
(Nameof-person acknowledgin ) (Name of person acknowledging
(Sign ture of Notary - (Si•nature of Notary Pub ic-St of Florida
INICHAEL MILEY i
Personally Known rS' .r1 �176�0 Personally Known. '' R Pro
ducCH-�gELf�.fiMcalEY
Type of Identification Type ofldentificati ' e�AY COMM�55�N E 1760
Commission No.ffir �� ,1ffii N Commission No.
FlwideN
REVIEWS. FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.712014
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