HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date; 15- A& Permit Number:
111MMIF1194111 W* _ RECEIV_D MAY 2 3 7016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division e� R
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
PROPOSED IMPROVEMENT LOCATION:
Address: �Gkk r1 -N l {{ "t A IL
Legal Description rx
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Property Tax 1D 4: - Lot No.
Site Plan Name: (1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION.IN_ FORMATION:.-
itiona onawor toa rme un ert �spermit-c ec a y:app
HVAC f]GasTank ❑Gas Piping _Shutters ❑Windows/Doors
Electric lumbing []Sprinklers [Generator Roof
Total 5q.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 5-0 GC' Utilities:0Sewer OSeptic Building Height:
OWNER/LESSEE:. `- CONTRACTOR:
Named-� ��^i.a EC Name: 1'l
Add r ss: I ompany:
City' CIV& tate, P- Address: .b (p
Zip Code: '� Fax Cty:�.(�- ,�(' � rC1C� State:_<..
Phone No. "7-70 - }a�,`y'�(�(n Zip Code: .39911!�= Fax:
E-Mail'C (�r, ( S`CAk CL-JC Phone No. q
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
IE value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEMLAW INFORMATION—
DESIGN ER/ENGINEER:
NFORMATIONDESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: ofi Applicable BONDIiVG COMPANY: of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 pe rmit 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 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.
_Signature of Owner/Lessee/Agent Si Co- r or "cense Holder
STATE OF FLORIDA r STATE OF FLORI
COUNTY OF �' �I���'�, COUNTYOF
The forgoing instrum n wa acknowledge before me The focigoing instrument was acknowled W. before me
this ia day of 20 40 by th day ofMs
Kk k .204M by
(Name of p rs(In ayknowledging) (Nam of perso acknowledging)
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(Signature of Nbtaty Publjc- o.' Pati Signatur of otary Public St to of Florida)
Personally Known onn Personally Known OR Produced Identification
Type of Identification Produce or,.'r- Type of Identification Produced
Commission No. pa�l�`S `Q�p�F� Commission No. •va!
cwr"ne?�nr
Revised 07/15/2014 �'''ale •• a%"1a`�'+ T V,2017
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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