HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: ' / Permit Number: /
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Building Permit Applica
CEIVED �
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Planning and Development Services2 6 2016
Building and Code Regulation Division APR
2300 Virginia)Avenue,Fort Pierce FL 34982
Phone: (7721)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: qo q
Legal Description: �C� COVE_j ti\ 1 � > Gr QL
Property Tax D#: ` a_�3a � � Lot No.
Site Plan Name: _t - /� Block No.
Project Name: ,. � -�(G� �r'U�-��
Setbacks.:. ;'F Qnt Back: Right Side: Left Side:
ty
`� yTr�-��`,x�"u e�Y_�> r��'t�` '=.`� r'.�€i�'z�;`";�5.r' '„�i it ,t�� >L a .�.= ` - Ii �"�s;P°z�x al1'L - Aa i I u^��. 't�s�.dHa •���l w�
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�L�CCLI�ST�RtICT��J�.�INFQRMATIO,N �r'� � ”
Additionalwor to b e pe orme un
der t is permit–checc all that appy:
Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electri —Plumbing _Sprinklers _Generator 1Aof
Total Sq. Ft of Construction: Coo Sq. Ft. of First..Floor:
Cost of Construction:$ « a06 Utilities: _Sewer _Septic Building Height:
r.,.;: '4 mss"` ^t' .x y„ '7i a ,� ��Cµh �d y "•� �, ,fir ' r q" �s�' "`" -�lu( " '^ s 5,. s�.,F{;*i
WNER LESSEE �� : ��R 7r CONTRATCR - g > p r
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-#i�",y:,; .°i;. -
NameOW-e. Name: e
Address:'.q!;9'0 R^_�� Company: Q D
City: o�,�� State: Address: s I �L�S N r 1
Zip Code:q Fax: City: E V State: F
Phone No. I�7„�– L��S_ GU6d Zip Code: 307 Fax:
E-Mail: Phoneo `��o)'4r, �q�60
Fill in fee simple Title Holder on next page( if different E-Mail Os: .A.
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from the Owner listed above) State or County License CC-'t�& >fj
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGIN ER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Address: �d0 „ �� Address:
City: -to? State: f-( City: State:
Zip: 3dqPhone 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 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
improvements to your property. A Notice of Commencement m st be recorded and posted on t
before the first inspection. If you intend to obtain financing, co ult with lender or an attorney I?
com cin work or recordingour Notice of Commencemen s.•
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Sign ture f Owner/Lessee/Contractor as Agent for Owner Signa r of Contractor/License Holder ? a 3. z
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STAFE OF FLORIDA STAT OF FLORIDA ? x a,
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COUNTY OF ��l� COUNTY OF ( H N -
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The or o►ng instru ent was a knowledg d efore me The instrume t was ackn wledged efor .meZ w s
thi day of �) �� ZOy this day of ( 20ny N o W
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(Name of person acknowledging) (Name of person acknowle ging)
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(Signature of Not ic-State of Florida) ota P blic-State of Florida)
ersonally Known OR Produced Identification Personally Known OR Produced Identification
T Type of Identification
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Produced ANGELA M HUFF
Notary a
• c Y Public-State of
Commission No. "sa t:c �Q Ei!);lon# ate of FloridaFor & Commission No. (Seal)
FF 730
My 0 Expires May 27,2019
Bonded th ou
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