HomeMy WebLinkAboutBuilding Permit Application {
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: I�� 020}._
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Building Permit Application
Planning and Development Services
t Building and Code Regulation Division
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1. 2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
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I PERMIT APPLICATION FOR:
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PR7P�S.ED 9NPRtlUEMEN{ i:QC !►TIt3N; ' "
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E Address:
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Legal Description: &ap'oh I S
Property Tax ID#: 4�- p?)(U - boo s -7 Lot No. leg
Site Plan Name: i Block No.
Project Name: 712
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTlO,N Of WfJRK n "
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Add mons I work to be pertormed under this permit-check all that appy:
Mechanical _Gas Tank Gas Piping Shutters i—Windows/Doors
s Electric Plumbing `Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft,of first Floor:
Cost of Construction: $ Utilities: _Sewer _Septic j Building Height:
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OV1lNER/LESSEE R C4NTRACTtiR,,' x i
x Name Name:_ rat
Address: �_(� (zi ler Oran.& Company:
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I City: i5or- -' Rerep State:JL Address:
Zi Code:
Zip q1 Fax: City: State: L
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Phone No. ' Zip Code:_ �� �l«p Fax:
i E-Mail: Phone No.�'11��
Fill in fee simple Title Holder on next page(if different E-Mail: fn ( , in
E from the Owner listed above) State or County License: La
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i if value of construction is 2SOO or more,a RECORDED Notice of Commencement is regaired. '
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f DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: T
#: Address: Address:
City: State: City: State:
Zip Phone: - Zip Phone: .
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFI[}VIT:Application is hereby made to obtain a perm-it to do the;work and installation as indicated.
l- I certify that no work or installation has commenced prior to the issuance of a permit.
f 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.
I The-following building permit applications are exempt from undergoing a full concurrency review:rloom additions,
! accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to anther non-residential use
l 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 orrecordin o r.Notice of Commencement.
Signature4fowner/Agent/Lessee Signature of Co or/License Holder
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STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF COUNTY OF 'I"• LuGe�.
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The forgoing instrument was acknowledged before me The forggIng instrument was acknowledged before me
this day of 1'Y1 20} by this day of II 201(0 by
P (Name of pers n acknowledging) (Name ofeha�i acknowledging)
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1 (Signature of Notary PubI tlo da, (Signature of Notary Public- a of Florida I
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,,++aRrnUe,,' DEBORAH RUSSELL t. !� ,:+,+'v r`' DEI�QRAH RUSSELL
Personally Known edcW �iflGatigRitP ryf Flr,f da �Personally Known 0 Ps �4de(�al } E�(1 �, , _,
Type of identification Pr a �=M 20rnrn.Expires Nov 3n,9n1t;Type of Identification Produc - �Flori
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~Nye o�Fwo� Commission#FF 179630 ti ) ��l Win.- Commission#FF 179630
Commission No. ",,, Bon I F or F��
� tallugh National Notary Assn, ommission No. ,ire
.. ._ �� � Qtttrough National Notary A.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ,� SEA TURTLE MANGROVE
i COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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i DATE
RECEIVED
DATE
COMPLETED I.
ev. 1/2014
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