HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INF MUST BE"COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Locals 119= 10'
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
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PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: X00 5ha ijnpi i r: fh
Legal Description: t &-( -m(od, Yr_ tIn; I Z 01 O`rT A) yZ Of LO•T / 7Q"d .5.=5_6-zs i7�
PropertyTaxlD#: I SDI• (old-I��US- -'�7' Lot No./7aHd 5•
Site Plan Name: Block No. cI Z
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.,OF WORK
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under INS permit—check all appy:
❑HVAC E Gas Tank ❑Gas Pi MGenerator
Windows Doors
Ping Shutters � /11Electric 0 Plumbing Sprinklers Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Z?J�5 Utilities:0Sewer[]Septic Building Height:
OWNERAESSEE: CONTRACTOR: .,
Name Name:
Address: L4s')ICompany: :E912. G Y_bprl'or S .:TG7c
City:(2UJN&►2621a6i'p State: �Address: i
Zip Code: ?:300 Fax: City: _ State:-
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Phone No. &,9(Q 200-7
�( Zip Code: aq� Fax: ?7«7/-63 7-7
E-Mail: Phone No. -g•?3 "d(o0O
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:C (� , e�9!3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU;P,PLEMENTAL COlSTRUCTION LIEN LAW INFQRMATION
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DESIGNER/ENGINEER: _Not Applicable 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:
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 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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Si ature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S? Lwc i.2 COUNTY OF ST L U r r.p_
The forgoing instrumt was
�nowledged efore me The forgoing instru�e tj
was acknowledged before me
ithis 3Iit 20&by thisl dayof
,20 /67 by
LJ JS ��P,rll�l-✓Z�� �'1 JO� S0N
(Name of person acknowledging) (Name of person acknowledging)
(Si atu of Notary' Pu-Sic-State of Florida) (Sig atur o Notary PubTic- tate of Florida)
Persona ly Known v R Produced Identification Personally Known �IiiF�e�kip
Type of Identification P du Type of Identification Pr d4�e�'r'oc Notary Public St rl_24' la
os ua Shane Alberico
Nohary Public State of Florida MY Com
Commission No. y �oshu4 �e Commission No. ,�'e Ei1 EE 827424
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Alberico xpires 16
Expiresm o8/1 E827424
827424
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS