HomeMy WebLinkAboutBuilding Permit Application ALL-APPLICABLE INFO MUST BE COMPLETED.FOR.APPLICATION TO BE ACCEPTED - d
Date: �4a1 1 �.�o Permit Number:
R E C E I D JUN w.4 2016
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
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Address: \ / -n V 1
Legal Description: �Ql)CQ�fl�l�.r' V I (1QS CAI'�Q' O
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Property Tax ID#: 3�'2,��` ���, �� e''` Q) C1 F �� Lot No.
Site Plan Name: (� Block No.
Project Name: S"CQ. Oo MS
Setbacks Front Back: Right Side: Left Side:
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A nal work toe e orme under this permit—check a appy:
E1HVAC 11 Gas Tank F]Gas Piping 11 Shutters lindows/Doors
11 Electric ❑ Plumbing Sprinklers FIGenerator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 3 $ . Utilities:Sewer OSeptic Building Height:
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Namen 6,ra r S I I'tp Name:
Addres .7-1 oo S. 0 cw-3)r. I.O 3 t Company: `
City: J wls State: FL Addre l L.
Zip Code: 3�9 S 7 Fax: City e
Stat
Phone No. a Zi Code: S Fax-
E-Mail:
� 4 - s3 5 a p U
E-Mail: Phone Kin.
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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 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
commencingwork or recordingour Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORI A �,, nn 1 STATE OF FLO ID
COUNTY OF ( .tYl \ 1�\ COUNTY OF CSC-" \
Theing instr t was acknowledge efore me The forgoing instrument was acknowledg efore me
rg
thisday of 20 LJQby thiay of 20
(Name of person acknowledging) (Name of'person acknowledging)
nature of Notary Public- a f Florida) ignature of Notary��OR
- ate of Florida)
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.rg:LSS92 (Seal) Commission No. 0 �(Seal)
i.+ 'b"•. MELISA ENTO
IF,-
?I, _uELISA ARMENTO
MY COMMISSION#EE 85
Revised 07/15/2014
EXPIRES: =*.
4:i P qZ`
Bonded ThN Notary Public Underwriters a I EXPIRES:December and 2016
_ % �P�,o� Bonded Thru Notary Public Underwrite
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
'C4/INITIALS