HomeMy WebLinkAboutBuilding Permit Application All APPLiCALE IIN�F (MUST BE COMPLETED FOR;APPLICATION TO BE ACCEPTED
Date: '1 ` Permit Number:
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~ _r a.. 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:
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M( ll+f t,
Address: PA r.���_i
Legal Description: L4L.�' 609 0 t(_ V P�t t Ste' L( qo " T- 6
Property Tax ID#: 1 3y k " 601S_ " t)0C) Qoo _ Lot No.`
Site Plan Name: ±�L1�, I. (� Block No.
Project Name: L.
Setbacks Front Back: Right Side: Left Side:
Run==
Additional work to be pertormed under this permit–check a ta"app :
_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: $ ,ycI(� Tic - Utilities: —Sewer —Septic Building Height:
Named3 Name:
Address: -e— Company: w r LL.- C
City: 2 Ci0 4 i rte. Address: r� b I °d
Zip Code: c "Fax: City: b v GL d1 {� State: '_-
Phone No. Zf 7 t{1 '7 Zip Code: 3 '2_e -7 Fax:
E-Mail: Phone No. q() .7–
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or 6e+H-rfiy License: C I S 0 W q 17
If value of construction is 2500 or more, a RECORDED'Notice of Commencement is equired.
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SUPPLEMENTAL CONSTRUCTION"IGEN LAW INFORMATION:
DESIGNER ENGINEER: NoC Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: T
City: State: City: State:
Zip: Phone: Zip: Phone: ��
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
Cit '
y: City: v
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 will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assopation 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 respect perform the work
in accordance with the approved plans,the Florida building Codes and St. Lucie County Amendma t .
The following building perm' plications are exempt from undergoing a full concurrency revie :r m additions,
accessory structures,swi iIf awls,fen es,walls;signs, screen rooms and accessory uses t ano er nan residential use
WARNING TO OWN R: Yr fai ret Record a Notice of Commencement may r suit ' your paying twice for
improvements to y ur pr per . A N Lice of Commencement must be rec r ed a d post n the jobsite
before the first ins ectior , I you int nd to obtain financing, consult with 1 der o an a orn y before
commencin wor or rec din ou Notic ' of Commencement.
Signature of Own /Agent/Lessee Signature of Con tr .tor/License Holder
STATE OF FL IDA j STATE OF FL O DA
COUNTY OF ANGE i COUNTY OF off +nc
The fo$ i strume s cknowled e ��ore ime The fpWing ins um n w acknowledgefb
ore me
this ley f___�� 20 "> this 1iday a _ __, 20 y
1 PETEf2 A CAFARb III FETTER A f.AFARU iii
(Name of person acknowl (Name of person acknowle ing j
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( ignature t Notary Public State of Florida I (Si nature o Notary Public State f Flor da j
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission No. EE 174164 YF `IIII mmission No. EE 174164 PC% Nol2,wI,GState o!FI4t, y{
Notary Punt ciState o!Fiori6n Kari M Riccaboni 1
Kari M Ri;clY,bon, _ H * to Commission EE t 74IC4
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05/2a+2010
o�F�o Exp res 05!2 2gt6 aino Expies
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
COMPLETE
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