HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 10 0' ' 0 0,�)
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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Address: 5-610 0
Legal Description: - I a' I
Property Tax ID#: 133 3 S0-a-00 3L-00 0 -L Lot No.
Site Plan Name: Block No.
Project Name: 7Th)
Setbacks Front Back: Right Side: Left Side:
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Aaditional work toe e orme under this permit-c ec a appy:
❑HVAC E]Gas Tank Gas Piping Shutters Windows/Doors
❑Electric 0 Plumbing Sprinklers Generator ❑ Roof
Total So. Ft of Construction: SFt.of First Floor:
Cost of Construction:$1969.x: 73 Utilities:]Sewer E]Septic Building Height:
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Name Name: �C� c�����l�c �'�,S - ° icL(L tri ei-
Address: S 9 - Company: �cr) SA �2 A Q_
city: F t-P w'Ce State: Address: 1, a b ( '75 0 A
Zip Code:„?i 991 Fax:c� City:j.t� lvti_a �
Pc-A C � �State:_ -
Phone No.51 1-335 g37 l� Zip Code:3sLl I a-- Fax:_51,I -SSSS•-CIO5
E-Mail: Phone No. (:/- 55- 4-1 (35—.P,
Fill in fee simple Title Holder on next page(if different E-Mail: �,
from the Owner listed above) State or County License: CG L" �- 5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is 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:
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 willauthorizethe 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-yourdeed 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 roomsIand'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 first inspection. If you intend to obtain financing, consult:with lender or an attorney before
commencing work or recording our Notice of Commencement.
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_SigY� �nature of Owner/Lesse gg_ tp� ture of Contractor/License Holder
STATE OF FLORA n STATE OF FLOWJ4_&OCI�
COUNTY OF —fib iA�s /�� J8�. COUNTYOF .
The forgoing instrument was a knowledged before me The for oing instrument was acknowledged before me
this 7i�day of IUG 20 Xby this day of, C 20 J by
lr �y�- a w12 S N,V1 5
Je of person acknowledging) (Name of person acknowledging)
—(Signature Notary Public==State. Florida-)--fl
Notary ublic-State of rida)
Personally Known OR Produced Identificationy1 Personally Known ---"OR Produced Identification
Type of Identification Produced 09U'A OR 61 CTR A& f Identification Produced ANG YOUNG
Commission No. clG'�'o� NOTARY PUemmission No. i �
_STATE OFF ORIDA °'AAY COMISfON t3 EE1B8835
2 EXPIRES April 12,2016
0WA Expires 3/23/2019 (4[17)398.0153 ReMallotMSemice com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS