HomeMy WebLinkAboutBuilding Permit Application 4 ALL APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: Permit Number:
®.: . RECEIV71 JUN 24 7,016
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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �j����,a X60
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Legal Description: � 1)0ar ►/.l I �C� ( 6►n 64)
Property Tax ID#: -39,Ad -- (oQ3- 0011 000 ZS Lot No.
Site Plan Name: Block No.
Project Name: T-0 c-'C—A
Setbacks Front Back: Right Side: Left Side:
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Additional work toe Dertormed under this permit—check all h apply:
HVAC 0 Gas Tank F]Gas Piping In Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ o� $//. / Utilities:cnSewer Septic Building Height:
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Name 'MClha I& 3• ( Q(zyl !0)pM c13 Name:
Address: '7q3U S. 0000„ 1,(- 322 b Company: 2 OcY'
City:- _MSQ,n 6GQ ol State:FL- Address:
Zip Code: 3'f Sl Fax: City: Stater
Phone No. 717 �7 S-- y q 4p Zip Code: Fax:c10 17 3
E-Mail: Phone No.
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.
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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 o otice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF 7FLO ID STATE OF FLORIDACOUNTY COUNTY OF GI Cc, V 1
Tg ing insfr ent was a knowledg e e me The forgoing instrument was acknowledged^before me
t�day of 20 thi§M day of 20 l lU by
Lo V)r�� V)a Chair-
(Name of person acknowledging) (Name of'person acknowledging)
nature of Notary Pub ic- tate of Florida) igna ure of Notary Pu lic-State of Florida )
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. r ea MELISAARMENTO Co mission No:,�E (Seal)
<° �''= MY COMMISSION#EE 85 25
-`' E)(PIRES:Decemher28, 016 ,,q.:Y'i i MY-GOMMISSIGNII-EH-5-58
MELISAARMEWO
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�.iff fy� B0° a EXPIRES:December 28,2018
Revised 07/15/2014 •�,�F;;�e.�• Bonded ThruNolmyPublicUndenx#ers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS