HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: °-Daae�eo Permit Number: 16d 5
RECE17D AP► 0.2016
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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:
PRC+?tJSEO INPItIVEMEIUT CATIQN + ra
Address:
Legal Description:
Property Tax I D#: �5�� 5 O, ^ 3 5 '4O0"q Lot No.
Site Plan Name: Block No.
Project Name:. 4fW Ala<lew !!�M
Setbacks Front Back:. Right Side: Left Side:
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DETAILEDFDES RIPTION' PWORK. 'e
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GON TivUCTI 1 INFOJv�M"' , i01Y �� "} K qti 7 m
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Acid itiona I wor k_to be per Orme e, under this permit—check all that appy:
_Mechanical _Gas Tank —.Gas Piping _Shutters endows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: s Sq. Ft. of First Floor:
Cost of Construction:$ /DD Utilities: —Sewer _Septic Building Height:
OVII ER ,LESSEE
Name40 LS Name: —
Address: cle Company:
City: $ State Address: r (,(1
Zip Code: Fax: City: State:
Phone No.l C2 Zs� T4� Zip Code Fax:
E-Mail: Phone No `
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County LicensecX0 is 7011
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of construction is 2500 or more,a RECORDED Notice of Commencement is required.
.,� ❑ +��r ro�7 yrs,�-.��fa�i � ��•+ `np��,y.�h+ � ��/ �" -. ����j� h�� �„� �¢-�
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: r 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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 ill authorize+the permit'hdlderto build the subject structure
which is in conflict with any applicable Home Owners Association rules;by,l_�ws or;,and covenants that,rnay restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restfictions 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'wlth lend'e "b'`r a' n attdrnby before
commencing work or recording our Notice of Commencement.
47.,
Sign ure of O ner/ ssee/Con ract as Agent for Owner rgnature of Co r ctor/Lic e der
SATE OF FLO IDA , ., < STATE,.0 - ORD ,►'
COUNTY OF LU c\ COUNTY O
The forgoing instrument was acknowledged before me The forgoing instrument as acknowledg d before me_
thi-Q,6 day of 20_\qby this day of 20by
(Name of person acknowledging) (Name of person acknoOMclging)
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(Signature of Notary blic-State of Florida) (Signature of Notary Pu c =State o Florida)
Personally Known OR Produced Identifica Personally KnownA OR'Rro •uce:d-t NNe fi -
Type of Identification >- GIVENS Type of Identificatio.
Produced "Y DEATSNP_.. of Ftocid'a ,=Y P..s°% Public-State of Florida
a State 016 Produced t „ Notary iresDec.1,6,2016
P,�O1ic ec 16,2 —'(� =l° . . _:My Domn 'Exp
�yY PUg��ry Notary, ices _ l ,. _ ;on#EE 858761 ,
CoriimssionNp.[,1= 5r ~P xA° ;MY( sloe#EE65a�6Ass ommission`.N.o� Co4(�onalNotaryAs� .{,
I' - rs Nota Y a ded Th
Cp Q Gorr uoh National , :>
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REVIEWS FRONT ZONfNG; SUPERVISOR PLANS VEGET.,TI.ON,. SEA TURTLE .'. MANGROVE
COUNTER . REVIEW REVIEW REVIEW ' REVIEW 'REVIEW' REVIEW
DATE
RECEIVED
DATE
COMPLETED
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