HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 atthe end of line
Address: c�U'j 1`� � T F--J 7j.PC Ck
Legal Description:�� �I 10 L U~ tP L-0 16
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Property Tax ID#: IQ L{0 10r• (0 n3 •>0 Q - 0(0(7)- -7 Lot No. 1T
Site Pian Name: l VVI X 1 Block No.
Project Name:,wt U 'P S
Setbacks Front Back: Right Side: Left Sider
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ACIOItional worK to 0e erformed un er t is permit-checK all mat appy:
HVAC Gas Tank ❑Gas Piping _Shutters I Windows/Doors
Electric OPlumbing ❑Sprinklers OGenerator Roof
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ U 3?• 5 L( Utilities: Sewer Septic ilj Building Height:
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Name me::.3G� �C-
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Address:3A524 SL4_2 5ca A UTAL- Company�)�
City: State:�L Address: 1,��{-1 -7 TH C� �' A�
Zip Code: Fax: City: E?c�- State.-F— --
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Phone No. 7 ai'n• �Y(v• 7 ! '� Zip Code:33�1 I a--- a Fax: 5141 SSS•�fy5-
E-Mail: Phone No. 5b 'R S7 L►S Q,
Fill in fee simple Title Holder on next page(if-different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNERANGINEER: i Not Applicable MORTGAGE COMPANY: i' _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone.
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FEE SAMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ! , Not Applicable
Name: Name:
Address Address:
City: City:
Zip: Phone: Zip: Phone:
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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 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,wails,signs,screen fooms-and'acsessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resultn 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 Fender o.r"an attorney before
commencing work or recording our Notice of Commencement. i l
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+Ignature of Owner/Lessee/Agent i ature of Contractor/License"Holder
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STATE OF FLORASTATE OF FLORl
COUNTY OF (' COUNTY OF
The forgog instruaae t was acknowledge before me The forgoing instrument was acknowledged before me
this ..day of�� 20 �by this a day of .20 �by
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(Nam of p rson acknowledging) (Name of person acknowlg-ging)
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(Sign t f Notary Public-State of Florida) (Signature of otary Pu licc--Stat f Florida)
Personally Known 11
OR Pr did ntification Personally Known OR Produced Identification
Type of Identification Produced Type of identification Produced
NOTARY PUBLIC
Commission No. NATE OF FLORIDA Commission No. ,i (Seal)
Comm#EE205440 2otrarP�glr� s;I ANGECAYOUNG
v MY!00MMISSI0N k FF 551069
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EXPIRES:Apr!'12.2020
Revised 07/15/2014 13ondedih.8,tge#NotaySe I.i
REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATIOW SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW i REVIEW REVIEW
DATE
COMPLETE
INITIALS
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