HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11 � rr
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 at the end of line
PROPOSED IIIMPROVEME'NT_LOCAT:I6N: .
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Address: b\15 Vk k5
Legal Description:
PropertyTax ID#: L`TZQ- �`� - �- (®—o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESG'RIPTION Q`F,WORK �i :x "
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CONSTRUCTIOyN INFORMATION
Additionalwork to be nertormed un er t is permit-check all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: rr�� S . Ft. of First Floor:
Cost of Construction: $ 1 V Utilities:)Sewer❑Septic Building Height:
OWNER/rLESSEE CONTRACTOR:
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Name ,l `e. Name: O_ lC
Address: Ori 'e- Company:
City: ( State: R Address: I
Zip Code:1 Fax: City: State:
Phone No.�_RZ Zip Code: 34-9 FM Fax: _17?__qco� L4(016
E-Mail: Phone No.-(2- 4(.Pi- 63 Zit
Fill in fee simple Title Holder on next page(if different E-Mail: cQmtY
from the Owner listed above) State or County License: (o43
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onstruction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.CONSTRUCTLON LIENIAMNFORMATION: " ' r
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 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 thepermit 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 an 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.
_ s
_Signat a caner Lessee Agent Signatur o Contra or/License Holder
STATE OF FLORIDASTATE OF FLORIDA n
COUNTY OF A���� COUNTY OF L MuL
The for ing instru e t was acknowledged before me The for o' g instru nt was acknowledged before me
this ay of 20 (p_by this ay of 20 �by
UaL�(,-- - . , � -�
_ q6:Ua=
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known 4s OR Produced Identification
Type of Identification Produced o .Identification Produced
BRENDA
Commission No. 1 I)Notary Public-stab. IG�t ssion No. � J u��� BRENOA MAJV.AV3
Commission#FF 2 1$85 .���` ¢. pOtxry,�Ob110•Strw o
My Comm.Expires Ma 1 2019
Bonded through Nztiopal Mary Assn. r My COMM.Expinr< 201
Revised 07/15/2014 '''•��°.�.1+`' Bondadttatw�lMNIOAsa
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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NITIALS