HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: �,�b001 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 V(
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the en'd of line
PROPOSED,IMPROVE_MENT.LOCATION -
Address:
Legal Description:�ilV2r�ctl'�wUtz-�IK ISr�.at 8'C(no 139?J200 :1 71-529=
2.�10—lar) ��/I
Property Tax ID#: '34IL I—S1 o-o(SU —000 Lot No.
Site Plan Name: A njf 510nol!
rr AA�� Imo, Block No. ( J
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK
:,CON'STRUCTION:,INFORMATION:
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Additionalwork to be nertormed under this permit—,heck all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric ❑Plumbing Sprinklers I Generator J Roof
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Total Sq. Ft of Construction: l Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:Sewer O Septic ,Building Height:
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01NNER/LESSEE:' "CONTRACTOR ;*
Name Name: C )` �
Address: (06) �_ St- Company: G a 00)—s Ce
City:40t- L.I {.C(� State: Address: 1 I (JZ cs Cc r{L �}VP
Zip Code:349(52, Fax: /016 City: t( cSVj((A- Stater
PhoneNo.'�71— Zip Code:32-7)9Ln I Fax:3�4 -2,COC(--)4 160
E-Mail: �� Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:Gh��oj— Q ecf?'�TS21y1'C�S G(�
from the Owner listed above) State or County License: 3 2,99 O 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU,PPLEIVIENTAL•CONSTR.UCTION LIENN.`LAW INFORMATIOz
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: .I.
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 holderito 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 Amendmenits.
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 inspec ' n. If y9p intend to obtain financing,consult with lender or an attorney before
commencing w4 your Notice of Commencement.
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_Signatu a of Owner/Lessee/Agent Signature ritra c7t6—r/C5ce ns7 older
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF �rv..Q�,�: COUNTY OF re �
The f oing instrument was acknowledged before me The for Ing instrument wa acknowledged before me
this�day of�� 20 f�by this��ay of G � 20(LP by
(N me of person acknowledging) (Name of person acknowledging)
ignature of Notary Public-Stat of Florida) (Signature M Notary Publ' -State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
e of I ntification Produced Type of Identification Produced'
�a�•ss�•�s-aa I
Commission No. .O(Seal) Commission No. :'t "°!%a.;
JEAWgWi DANIELLE VOGEL
MY COMMISSION#FF114946
EXPIRES April 2 1, 20 its
OfP,,
Revised 07/15/2014 (407),398-0153 FloridallotaryService.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
1 N ITIALS
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