HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (0 'a• ,�� Permit Number: �� d �o• b �'
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• I RECEIVED
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Building Permit Application JUN /2 2016
Planning ar�d Development Services
Building and Code Regulation Division
2300 Virgin is Avenue,Fort Pierce FL 34982
Phone:(7 2)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRCOPOSED IMPROVEMENT LOCATION:.
Address: 3 F 12 Pe)
a C� / /�
Legal Description: .-/�✓d nda 6'wb 21 2 e 7'!j/, I?,Cl _//? `QTL�
Property Taix ID#:_���5 70S"0090-O�JzJJ-S Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D'ESCRIPTION!'OE WORK: ,''
1�Cro�T I C�a� o�i °nJ4//U
CONSTRUCTION INFORMATION:
Additional iwor to e e orme under tis permit—c ec a apply:
HVA11GasTank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: I d*7' Sq.Ft.of First Floor: 16,7,q
Cost of Cor
nstruction:$ `I t 30o Utilities:USewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name L o l n a ����.rT✓!G'r Name: )3r.� a h
Address: 3 X107 1 J6ru ( C� Company: re 4
City: ')9,41 ,Sa. Gvc;B State:.L-L Address: —1o/ SW hf J
Zip Code: Fax: City: Lvc.' State: Az
Phone No. Zip code: 31/9k1y Fax:
E-Mail: Phone No. 7'7,?-370 -017 7e
Fill in fee simple Title Holder on next page if different E-Mail:_TL Poo _� L L CC>q yna,'I.�Q,l
from the Owner listed above) State or County License: G c c- i 33 eJGS-3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE 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 Coynty 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 followinlg 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.
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Signature of ner Less /Agent Signature of Cont or i_c Holder
STATE OF FLOR14A STATE OF FLORIDA
COUNTY OF COUNTY T �yc� C COUNTY OF J"T 1,116,e
The forgoing instrument was acknowledged�efore me The forgoing instrument was acknowledged before me
this Z day of ✓IP 20 1 G by this .2 day of 20 J/ by
(Name of p rson acknowledging) (Name of person acknowledging)
� ^\`ez��4it�T°BRUb°°°fig ���..✓
(Signature of Notary Public-State of Fifri •. ��SSIONF••• '%. {Signature of Notary Public-State of Flog'�aT BRUN
•°° ay 1zr 20,x°9: .�`L Q ••"sio
Y N t Y X' OR Producg�Id \ F �Oi'• ��
Personally Known OR Prod �edic'�entification Personally Known
Type of Identification Produced 0.6m _ Type of Identification Produced o :
#FF 17434
Commission No. �� �?° �onded�hN�� oQ Commission No./ / = if ••o
^� o gec; '2 '.�Se 122434 ;Q
i� y Notary, �F�`w X20 �. 5
`'� '0.. .. STA�F °� y,�99"Bg'�tltary$e�"dLI
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
COMPLETE
INITIALS i