HomeMy WebLinkAboutBuilding Permit Application All APPLICABI L =OMPIETED FOR APPLICATION TO BE ACCEPTED
Date: l Permit Number: ( CDC
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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
PERMIT APPLICATION FOR: yo 5^43,1 �� ��-}�r ���er- cjla-/)
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Address: 2.7 Or-1-
Legal
rte.Legal Description:
Property Tax ID#: 813 9- -�90 b- Ob 70 - 6)20 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical __Gas Tank' _Gas Piping —Shutters _Windows/Doors
Electric ✓Plumbing ��11 _Sprinklers _Generator _Roof
Total-Sq'' Ft of Co,nstruction:- 0 L �(/' Sq. Ft. of First,Floor:
Cost of Construction: $ �a�•0 O Utilities: -Sewer _Septic Building Height:
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Name
Address'.-.^ 2.70 LX•a o �i�. pany:
City:��. 1�i�C� Sat Address: / 7U/ r 3 `f S
Zip Code: Fax: City: ri. A-c -cue- Stater
Phone No.010 Zip Code: '9 155,1 :7 Fax:
E-Mail: PhoneNo/-77?,d 201' &073
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 911?010 6
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
J, i P EMiENT�A� CONS,fR�.UCTI:Or= I`E�N I FO , M �TLO'
ESIGNER ENGINEER: Not Applicable "'`
� / — PP � 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 County makes no representation that is granting a permit will authorize thepermit 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 the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing w k or recording our N4ce of Commencement.
Signature of Owner/Agent/Lesse Contractor Signature of Contractor/License
STATE
COUNTY OF ORIDA / �.L STATE OF FLORIDA /
COUNTY OF L,
The for ping instrun t was acknowledged before me The for ping instrument was acknowledge before me
this day of 20 y this �' day of�'C 1 20�y
C~� � �I'✓�c Ste_ ��� E � -�S�'�
(Nae'of person acknowledging) (Name of person acknowledgin
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(Signature of NJry7c-State of Florida ) (Signature of Notary u ic- tate of Florida )
Person ANGgripat} ¢I Identi ' ation Personally Kno n OR Produced Identification
Type o d �� " n Notary Public-State of Florida Type of Identifi i
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Produc 'r. #►FF 234730 Produced ,••o •�,
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Commis iohr,, ;°P'� edthroughNationalW Commission N .z�' �rc Commission#r`��I�i°rlda
°;.F°P� g nded h ou30
Expires MaY 2772019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/201