HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h_ /
Dater Permit Number: `� 1
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
Address: , IC #c
Dollar
Legal Description: SCod o llar Vi IIQS enclO
Property Tax ID#: 3$,141 a 3I — QQQ I -- 05 d / Lot No.
Site Plan Name: Block No.
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Project Name: �. onr�1 C lO)(CI!.Y'' Sb ores
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Additional work to a Dertormedd un er this permit—check all appy:
ElHVAC Gas Tank F]Gas Piping Shutters Windows/Doors
ElElectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost'of Construction: $ .3, D S7. Y(o Utilities:nSewer[]Septic Building Height:
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Name .� oS brd rQ Jox�ar S �Y Name:
Address: 7N20 S. 0 Dr. 1I5 Company: A WN �r 7
City: JQ.Y)SW GLi State: �L Address: �l O 1
Zip Code: 3L4C15 7 Fax: City: Staters
Phone No. T IQ A,99- 535a. Zip Code: 33�g Fax:,5(6� _7H 3-QS32
E-Mail:, Phone No. c Pacl
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. MORT GAGE 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
comme or recor In Notice of Commencement.
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_Signature of 0 essee/Agent Signature of Contractor/License Holder
e __?
STATE OF FLOR DA STATE OF FLO A
COUNTY OF— COUNTY OF (Y1 U+
Te In instrment was acknowled before me The forgoing instrument was acknowledge before me
t t ay 20��by this ay of 20 �by
_;� ' ��2 Lci:\�, _Ji
(Name of person acknowledging) (Name of'person acknowledging).
\(I �] .�� , I WV_ __ __ , C-D
Signature o Notary P
ublic-State of Florida) Signature of Notary Pu 'c-State of Florida )
Personally Knowny OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 1,) MELJSAARMENT Com 'ssion No. r (Seal)
'z4 MY COMMISSION#EE 5825
r2 ,2016
UPI ISA marm*g• 'r MY COMMISSION#EE 855825
Revised 07/15/2014 �: EXPIRES:December 28.2016
EXPIRES:December 28,2016 % F•'dt' Bonded Th.Notary P.He Underwriters
Bonded Thru Notary Public Underwriters "P^
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER- REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS G