HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFb6,MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l�
Date,J a .. Permit Number: `fid 1–d 1
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RECEIVE-0 JAN 05 2016 ^
Building Permit Application
Planning and l7eveloprAent Services
Building and Cade Re ylation Division
2300 Virginia Avenue,I 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 litre v �;
Address: Q
or-
Legal Descripti ns ' 6
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Property Tax ID#: 012-15Lot No.
Site PlanIUame: Block No._
Project Name:
5etbacks Front Back: Right Side: Left Side:
�s � ro
1 r na wor to e, a orme un er is perms –c ec a app y:
MVAC GasTank Gas Piping _Shutters ❑Windows/Doors
>LIElectricPlumbing OSprinkiersGenerator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
rte'
Cost of Construction: Utilities;11 Sewer ElSeptic Building Height:
Name I' Name:
Addr ss:-MIG Company:
Ci State: Address:
Zip Code: Fax: Cit • State:
Phone No. Zip Code: Fax:
E-Mail: Phone No. •
'Fill in fee simple Title}bider on next page(if different E-Mail:
from the owner listed above) State ounty License:
If value of construction is$2500 or more,a RECORDED Noticq of Commencement Is required.
EO/Z0 39dd NIV HOd3E N3SN3f 6ELSESEZLL 81?:Z0 TTOZ/EZ/60
bE51GNER ENGINEER: Not Applicable MORTC,�GE COMPANY: _Not Applicable
Name- Name:
Address: Address:
City: ? State: City: State:
Zip: Mone: Zip: Phone:
FEE SIMPLt: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 rib representation that is granting a permit tivill authorize the ermit holder to build the subject structure
which is in conflict with airy applicable Home Owners Association rules;bylaws or ana covenants that may restrict or prohibit such
structure.Please consultwith 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.
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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 yourproperty.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; recordingy9jur Notice of Commencement.
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Signature of Owner/Agen Lessee Signature of Contractor/!_Ici ruse Aolder
STATE OF FLORIDA '; STATE OF FLORIDA
COUNTY OF _ _ __ COUNTY OF
The f�g, Inst ti s knowledged efore me The oing inst merit w s k owledged afore me
this-�"Pyo rRimill 20 40by this ay o 204(oby
off wtu
(Name of person acknowiedgi ) (Name of pers n ac o ledgin )
(Signator ry Z7 Stat of lorida} (Signature of Notary Pub' -State of Ior da)
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Pr6duced Type of Identification Produce
Commission
Commission N'o. eal) Corrlmission No. `� f L40 al)
j CRYSTAL MARIE CRU 0 CRYSTAL MARIE CRUZADO
=": •'a SAY C OMMIMSION it EE197463 '" MY CpiiWMISSIQN#E5197463
Revised 07/15/2014; EXPIRES June 2!b,2016 EXRRES June 25,3016
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS j'
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