HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLtTED FOR APPLICATION TO BE ACCEPTED---`_.
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Building Permit Application
Planning and Development Services -
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34382
Phone: (772)462-1553 Fax:(772)-462-1578 Commercial Residential
PERMIT APPLICATION FOR: Ze.rooc- oe-cacc.Ac_b
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Address: t31� S • ��L 4 ��
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Property Tax lD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks .Front Back: Right Side: Left Side:
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Additional work to be performed-_under this permit—check all that appy:
_Mechanical _ Gas Tank _Gas Piping —Shutters Windows/Doors
s Electric _Plumbing _Sprinklers —Generator X Roof
Total Sq. Ft of Construction: Q f6o Sq. Ft.of First Floor:
Cost of Construction:$ 7 `f °' Utilities: _Sewer _Septic Building Height: '
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OWN R LESSEE. RACTOR � � 1_
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Name (tecoA0 gordc,.A w- g VIl- 5-%'34 Name: �L't We4.%&Ay&Z
Address:_ Ylio� � L f• Company: AC.� Cc-A--_4__r
City: (bra( "'b State: Address: 1 TS1 Ac (A Lo i�Ac-
Zip Code: 2131 Fax: City: State:
Phone No. Q7�1 0'717 Zip Code: 31gil( Fax: ,72 2.7t
E-Mail: 4ot. • to^— Phone No__22
Fill in fee simple Title Holder on next page(if different E-Mail t-6Yf.ernc.�ez. �4"` •• ��'
from the Owner listed above) State or County License c Gc. 0.57ZSY S'
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PPL ENTLON . UVIlNST0 4-7
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _,I( Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: T Nat Applicable BONDING COMPANY: Of 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 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 the jobsite
before a first inspection. If you intend to obtain financing,consult with lender ora ney before
comm n ing work or recording our Notice of Commencement.
Signature of Owner/Lessee/AgenT Signatu a of Contractor/ a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF IIJ V 0
The forgoing instrument was acknowledged before me The forpyng instrument was acknowledged before me
this_!k_day of_ 20�a by this 7"'day of F Cq A(CJ ,20 by
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(Name of person acknowledging) (Name of erson acknowledging)
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(Signat_ -ure=of Notary=P `Iici;Sta ebf Florida) (Signature of Notary Public-State of Florida a
Personally Known �OR Produced Identification Personally Known ✓ubOR Produced Identification
Type of Identification Type of Identification
Produced Produced
oV 00 Notary Puglia SMIR Of Fladde "� E WE0
Commission Na. ;g ^, And 4 :, MYCOMMI 924654
r�1Y Gomm SSRn 6t:1$8284 Commission No. ' g IRES:N��9.2019
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REVIEWS
Expires 041031201G8ond�dThNN NPtds9CthNletrntas
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.712014