HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 I(go Lt-
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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 end of line
Address. KCA Z l L 1
Legal Description:,Tf c-s,�,nn I 1 ,5 S ev 1 zvG3,Ys
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Property Tax ID#: 1.3 0-6 — l 1 1 — 00o 1 000 Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional workkto be nertormed under this permit-check all appy:
11HVAC Gas Tank Das Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
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Total Sq. Ft of Construction: y� S . Ft. of First Floor:
Cost of Construction:$ (� Utilities:Sewer Septic ! Building Height:
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Name_ O :(' )1 �M Name:
Address: U16c PLC CL Company: Q r OA, O
City:rot ?I erne. State: Address: 3 Lam ,
Zip Code: Fax: City: O e Stater
Phone No.�M Zip Code: 3 Z/�(g Fax:
E-Mail: Phone No.-)W— <201r�
Fill in fee simple Title Holder on next page(if different E-Mail: L 77,
from the Owner listed above) State or County License: 13
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPL l�IENT L CONSTR CTIg I LIE i LAI, �N QR@fiAT1 3[ ON-.,e ,n,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:.,} _Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Ph e:I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMP Y: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: P one: Zip: Phone: I
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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 covenantslthat 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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!O � e of 0 ner/Lessee/Agent SigrJure of Contractor/Licen'se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 1U�-V—LA,--C• -!!/ COUNTY OF S1 .
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The for oing instrument was acknowledged before me The forgoing instrument was lacknowledged before me
this day of 20 / by this hJ day of 20 Ib by
P.
(Name of persbn acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Stat f Florida ) tgnature of Notary Public-'State of Florida)
Personally Known OR Produced Identific tion Personally Known OR Produced Identification
Type of Identification Produced A 2 Ty, ef Ide tification Produced
Commission No. r ear•-- commission No. (Seal)
JESSIE PIQUION
lintgry Public.State of Flori a f
Commission#FF 4772 ^.�a�S%AViva(',
Revised 07/15/2014 My comm.expires Apr.27,2017 20� Notary Public 7De
Florida
;• My comm.Exp01 B9„;+. Bonded Through ssn.REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAT IE
COUNTER REVIEW REVIEW REVIEW REVIE '%REVIEW REVIEW
DATE .
COMPLETE
INITIALS