HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN/FOO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /• l Permit Number: I V 7• �a,.
RECEIVE
Building Permit Application JUL ® 7 2096
Planning and Development Services
Building andiCode Regulation Division.
2300 Virginia Avenue,Fort Pierce Ft 34982 /
Phone: (77I)462-1553 Fax: (772) 462-1578 Commercial I/ Residential.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the.end of line
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Address: S Jnr op-Aue.
.Legal Description-7 l56— 1k �.(aga3��CpAAONIil%L(tf'1
Prope.rtyTa x ID#:; ^Q Lot No.
Site Plan Name: �i 17 �rLS Block No.
Project Name: S-Sl��l(� c"Vte5
Setbacks Front Back: Right Side:- Left Side:
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Additional wor to be er orme un ert is permit—c ec a apply:
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_HVAC Gas Tank Gas Piping _Shutters Qwindows/Doors
Electric 0 Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Cor struction:$ / d� . Utilities: Sewer Septic Building Height: _
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Na ne n Name: == ' �
Address:— �� KJ�. Company. F�
City:JPn5l en State Address: ' - bi O .f7l
Zip Code: 5Fax: City: IcL SSta��ter
Phone No, '���� - �� Zip Code: L�� Fax: �
E-Mail: Phone No. 3Q, f(J—RO V
Fill in fee'simple Title Holder on next page(if different E-Mail: 1r 11Mi0&LCs+e_11eJffJ,0JC,CM
from the Owner listed above) State or County License: (� �1
if value of'construction is$2500 or more,a RECORDED Notice of Commencement is required..
A��\.::t^u'>��' .
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: ' Address:
City: i State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLD_ER• _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City- City:
Zip: i Phone:. Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countty makes.no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in confjlict 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 ofthe 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
commencin work_or recording our Notice of Comme'.nce.ment.
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_Signature of, wrier see/Agent ignature of Contractor/License Hol r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFI . �acl`e COUNTY OF
The forgoing instrument was acknowledged before me Thefor�gLoing instrume t vras acknowledge fore me
this��day of /9 20 &by this ��" day of 20 by
�Vo/vy .�?u UtY D -
(Name of personacknowledgin ) (Name of person acknowledging)
(Signature of Notary Public-State of Floridar ) RR g ature of tary Public-State of Florida J
Personally Kncl` OK'PrtYQtJt7�'H'IL7A�ITiP h Personally Known 1.-� OR Produced Identification
Type of Identifi a r~LWcpOMNMISSION 4 FF1198597 Type of Identification Produced
EXPIRES February 11,2019
Commission NC J407►388-0153 CO" Commission No.
da pPLO�n Pjotary Public State of Florida
�. a Josephine Traber
fission FF 21721a
Revised 07/15/2014 eFr�O ExPireso5i1oi2o1s
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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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