HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:---
-Permit-Number
F11 E 1=i 1�VEH D
................ ---------- Building Permit Application APR2 8 2016
Pla nning and Development Services PERM UTTING
Building and Code Regulation Division Si. Lucie County, FL
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
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Address: L/ 90 9 v , a
Legal Description:J In t� nV Q - 11 Z,074S /?
Property Tax lD #: 3qQa- 100to- Ck';Iq q-OL22-9 Lot No, q
Site Plan Name: Block Nc).
Project Name: -bi(I11 e
Setbacks Front Back: Right Side: Left Side:
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Additional w8�1<tobe performed under this permit-check all appy:
HVAC E]Gas' Tank oGas Piping MShutters ❑Windows/Doors
Electric 0 Plumbing OSprinklers 1i Generator F—] Roof
Total Sq. Ft of Construction: �I Sq- Ft. of First Floor:
Cost of Construction:$ 3o0 r OC) Utilities: Sewer E1 Septic Building Height:
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N a m e�11(A'c'e- Name:
Address: f. Company:f) l �e'o 1 C iA�
City: IR> 1'r?A C-Q State: Address:�<?Q k 5, tkS k-\w -J
Zip Code: Fax: City: J
State: 1:1-
Phone No.
Zip Code:3L-L d Fax::2a-LJ 6LI-Lp(o00
E-Mail: Phone No. -11-a-H Ua L4-6 0C)
Fill in fee simple Title Holder on next page if different E-Mail:-� Y-A a�A o-Tua f\D,Com
from the Owner listed above) State or County License:o,�2-c'130(, 1 in
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 App licable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 appl y.
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.
//Z'��� A,,, ,- L'/< N'
Sig ture of Owner/Agent Lessee Sibiafure of Contractor/License Holder
STATE OF FLORID 1 STATE OF FLORIDA
COUNTY OF , 1,c, (�� Q COUNTY OF :54, t4Ac 'Q
The forgoing instru entw sacknowledged efore me The forgoing instrument was acknowledged before me
this h day of 20 1 by this lgday oft v^t ,20A by
(Name of person acknowledging) (Name of person acknowledging)
Si ature of Not ry Public-State of Florida) ature of Notary'Public-State of Florida)
Personally Known OR Produced Identification Personally Knowny ubOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,of°�vP�g��Seal).-:j .tt�IFEROBET Commission No. o,Pa ea(S
r`• •., ,IJNNIFEROBERT
MY COMMISSION#EE 215904
Neymbff 12,2016
Revised 07/15/2014 lFOF FL6'N Bonded Thru Budget NoLry Services j'rec�F�o�`OP Bonded Thru Budget Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS