HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED nn��
Date: Permit Number:�D`��.0a 4
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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: To Select from dropbox, click arrow at the e1hd of line
PROPOSED IM'PROVE-MENTLOGATIOIVM
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Address: AA-
Legal
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Legal Description:
Property Tax ID#: _ `-tom 5- -502-- - QW-9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
`DETAILEDDESCRIPTIONkOFWOtK
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COISTRUCTIONINFORM/ TION,=
Itional workkto be nprtormed under this permit-c ec k all apply: p
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
RIElectric 0 Plumbing ❑Sprinklers 0 Generator ' �'_Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ �'T, )�� Utilities: _Sewer O Septic Building Height:
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01NNER/L'ESSEE i }<
CONTRACTOR:
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Name 012 Name:
Address: Lcc D Company: Wn o t I ,L
City: JX CKk State: Address:
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Zip Code JL(q92_ jFa�xx: City: � r�P 'CSL � Statue: _ r
Phone No--M �L�(p�(--C"L�G� Zip Code: 33WC Z � Fax
E-Mail: Phone No..-TI2- 1,.-S3
Fill in fee simple Title Holder on next page(if different E-Mail: o, Y-n
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. P
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SU.RPLEM'ENTAL,CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 a,nd 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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_Signatu e'of Owner Lesse g Signatu a ontrac or Lice se Ider
STATE OF IDA STATE O RID. ,
COUNTY OF L
Q eft COUNTY OF c _'�� CU-
The forgoing inst ent was acknowledged before me The forgoing insr_&
ent was acknowledged before me
this day of L 20 l ,by this of 20 L'Lo by
(Name of person acknowledging) (Name of person acknowledg'e'i g)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No\ •�������• eal) BRENDA MARTINE Com ission No
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O % Notary Public•State of lorida ,.��, BRENDA MAR Z
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Commission FF 23 565 =' `¢�. Notary Public-State Florl
My Comm.Expires may i = 1585
Revised 07/15/2014 S",0� ••• Bonded through National Notary Mq °pf My Comm.Expire:Mai 1.21
Bonded thraigh Monal t Mary A
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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