HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6- �~� �o- Permit Number: 16 d - 3/z,
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DECEIVE®
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' Building Permit Application
Planning and DevelopmentServices JUN l�e 1 5 206
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential T
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PERMIT AO, PLICATION FOR: To'Select from drop box,.click arrow at the end of line
.,11 EQ IMPROVEMENT LOCATION
Address: f`e-v e. L 3
Legal Description- C PI- 1KIAIrt
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Property Tax ID#: 0-0 6' Q Q Q 0 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
&C- CZ pt Filel-k J,� J1_6
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CONSTRUCTIQN INFORMATION
Additional Work to e orme under tispermit—checka appy:
F]HVAC LJ Gas Tank ❑Gas Piping _Shutters El Windows/Doors
�Electlic Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: >a J Sq.Ft.of First Floor:
Cost of Construction:$�/ ,S d d Utilities: Sewer Septic Building Height:
OWNER/.LESSEE 'CONTRACTOR
Name �� G �(�� C Name: cz C
Address: v Company: ( C 114,
City: �_ `State: P-L_ Address: C 03 E tc.— 6c
Zip Code:5 z lc,5)-- Fax: YIV City: F fi l C,-r i State: r_<1
Phone No.1 y a -- b SC 6 Zip Code:5 Fax: 7 7���{6��C�S'
E-Mail: Phone No.
Fill in fee simple TIR4 Holder on next page(if different E-Mail: ce Uel CQd
from the Owner listed above) State or Conn License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEME}NTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address; Address:
City: State: City. State:
Trp: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: ;= Name: ,
Address: I Address.
City: City:
Zip: I Phone: Trp: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit_
St.Lude Comakes no representation that is granting a permit will authorize the Qermit holder to build the subjectstructure
which Is in coict with ar appCcable tome Owns Assoaatron rotes,bylaws or and covenants that may restrict or prohibit such
structure.Please oonsuR with your Home Owners Assoaation and review your deed for any restrictions which may apply.
in consideration of the granting ofthis requested permit,l do hereby agree that i will,in an respells,perform the work
in accordance Eft the approved plans,the Florida Building Codes and St Jude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions, -.
accessory stru6res,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING' O OWNER:Your fAure 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
comroencink work or recordin our Notice of Commencement-)
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_Signature of Owner/L,essWAgmt Signature of COntraCbDi/LtcenSe Holder 5
STATE OF FLORIDA y STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing" errt was admowiedged before $ g The forgoing i errt was acknowledged before m o c
this�dayof 20/. "�7°
z' � thls�s. day of 20 _W CE r ("17(A, 0 a/y �
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(Name of person acknowledging) �_A (Name of person acknowledging) p
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(Signature of obary Public-State of orida - (S r�gnamreof ry Public-State of orida)
Personally I(nown /OR Produced identification Personally Known _ OR Produced identification
Type of Iden IUficadon Produced Type of Identification Produced
Commissio on No. (Seal) Commission No. (Seal) ,
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Revised 67/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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