HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APP_ LICATION TO BE ACCEPTED
Dater (a� Permit Number: Si
RECER _D.JUN 24;1 116
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: 11 1
Legal Description: Jan ![. �l�CUC V I Ip►S OY1 C7
Property Tax ID#: 35aaa —it — 0018 - 06. 0 Z Lot No.
Site Plan Name: 1-_ Block No.
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Project Name: 0 11CIX- Im rLs
Setbacks Front Back: Right.Side: Left Side:
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A PGT 200 5H (�R
I = PG-r t9-► 4 ML.II (DRQ
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= CGL 360 s 1 (k) XHP13GT-
A itiona work to Se nertormed under this permit-check all appy:
HVAC U Gas Tank E]Gas Piping _Shutters ED/Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:.$- 2, :200 .q1 Utilities:Sewer E]Septic Building Height:
Name F1r2C�wiC d- Kci Iun Fair-O Name:
Address: 14/D S. 0 405 I' Company:- V QCl' u.
City: 2(�S 2.Q State: FL Ad�r.� v
Zip Code: 3"15!-'7 Fax: City: A
�l Stat :
Phone No. (D ash 'tJo� Zip Code: ft 21l2� Fax:
E-Mail: Phone (1(S<_
Fill in fee simple Title Holder on next page( if different E-Mail: 2 ii
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 o end to obtain financing, consult with lender or an attorney before
commencing ecordin our No ice of Commencement.
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_Signature of O Lessee/Agent Signatur of Contractor/License Holder
STATE OF FLORID STATE OF FLORID_
COUNTY OF COUNTY OF C-
=day
Ing instrcrrf e'nt was acknowledg d efore me T or tng instru ent was acknowled a before me
of 20y th' day of 20J�by
(Name of person acknowledging) (Name of'person acknowledging,
Ignature of Notary`Publi/c-Sta e of Florida ) (Signature of NotaryVOR
-State of Florida )
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Produced cC Type of Identification Produced
Commission No. SZV ( ;svP$••., MELISA ENTO No.E-F �' (Seal)
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MY COMMISSI N#EE 855825
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MELISAARMEfJTO
Revised 07/15/2014 ' _
*; 4 MY COMMISSION#EE 855825
•, EXPIRES:Dec
,P,f, �`� on ru otaryPublic Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TUR
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE �/ r
COMPLETE 10
INITIALS