HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:e . I �� f Permit Number: REC
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Building Permit Application DEC 2 3 2015
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:
Address: 3 '�^
Legal Description: QzJ" S Q "�o Co r S$9
Property Tax ID#: '`. tom ,`f. (p ' .5-0 9, U C) 0 0— Li Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona work to be performed un er this permit-check all that appy:
_Mechanical • Gas Tank _Gas Piping Shutters,:' _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ") of 000 Utilities: _Sewer —Septic Building Height:
Name ^ 54,e., P"I k Name: Nn .1rz
Address: �-O_S_5 Company: i9k -J1kta,
City: '1rJ f low 61-00,2 Stater Address: PC) 604 65 0%
Zip Code: c D -oeW Fax: City: Ver-0 6-e4--'_k State: )C-(
Phone No. - 7. Zip Code: 3 a (oS Fax: °7?'a`R-$ -51,5-0
E-Mail: Phone No. -7 - q-78 'SG 5-
Fill
Fill in fee simple Title Holder on next page(if different E-Mail: G&`�rc l Kti Co' n54-C L" rI
from the Owner listed above) State or.County License: CGC 15-1 &11�
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 Counter.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 be recorded and posted on e,
before the first inspection. If you intend to obtain financing, consult with lender or an attorney
commencing work or recording our Notice of Commencement. o•.
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SigrLdN of CA er/Agent/Lessee _?�,~ Signature of Contractor/License Holder 2 my'm
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STATE OF FLORIDA a STATE OF FLORID o
COUNTY OF a x~ COUNTY OF 'T
2mEMm aona��
The forgoing instriURprit was acknowledged befo L!9r-m The for oing instrument was acknowledged b `4R�
this.2, �20�by Dz� this day of �� . ;-20�
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Irl .,lel IA 1 82 622,.44--Z /!1_/ �
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of VFary Public-State f Florida Signature o tary Public-Sia f Flor da)
Personally KnownR Prod a Identification / Personally Known O Pro b ed Identifi ation
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW.. REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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