HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t� U
Date: yT��� Permit Number:
u .- RECEIVED APR 0 7 2016
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 end of line p �O
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Address: I CC) aQ QQ t— A—L)
Legal Description: \o e-'c- PC>,6—V- lh AC -
Property Tax ID#: t - 5 L D d 1 _Lq 000 s Lot No. u
Site Plan Name: 1� Block No. )
Project Name: LJ! ec LO L1x�l'L-1l
Setbacks Front Back: Right Side: '`:;Left Side:
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Additional work to be errormed under this permit-check all that appy:
IIHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers En Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 19 D,�.4�-� Utilities:Sewer E]Septic Building Height:
z-NO WIN
Name^ e_�01 k U 10 .KC)(A.--) Z t:Li Name: qjeJ- -ter-
Address: y k�J C Q CIO k---) L3+- AU Company:-,:]_�(n
City: S-* L.)C% State:_2L Address: 1�, 4 tc �1�'TFfj 0�
Zip Code: 3 L49 S D- Fax: City: State:-F
Phone No. '-? 7 -��. 3 1�-"/ Zip Code:-33L1 I D— Fax: 5(0l .�i S'S'•pfd
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E-Mail: Phone No. (�/- Ste- SOS
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r
-M- MDESIGNER/ENGfNEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
i City: State: City: State:
j 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,p-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, consultwith lender or an attorney before
commencing work or rgcording your Notice of Commencement.
s
ignat_ ure of Owner/Lessee/Agent i ture of Contractor/License Holder
STATE OF FLORJ�DA STATE.'
FLOF�A /
COUNTY OF ,^RC1 I i� UA&C C COUNTY OF Va I hn 9,PG Cly
The for oing instrument was acknowledged before me The fo oing instr ent w s acknowledged before me
this Lday of (i6'1 , 20 {Eby this day of 20 L by
grac4N mi Iicr l I Gail'
(Name of person acknowledging) (Name of person acknowle ging)
� ignatwre�of4N86k, V,UbIi&,State.of Florida) (Signature otary blit-Stat lorida)
Personally Known OR Produced Identification '� Personally Known�R Produced Identification
Type of Identification Produced f)(IG11% M1/1'�SL�C•P Type of Identification Produced
NICOLE ORTADO ����
NOTARY PUBLIC Commission No. o eY �� 4Seal)YOUNG
Commission No.F�)��� STATE OF FLORI 2 •'•• 0
MY COMMISSION#FF W069
r e� Pn 12,[GG
Expires 12!1/2018
Revised 07/15/2014 9rF0FFiO�\ BandeGThru8ud9etNatarySertes
REVIEWSFRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
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