HomeMy WebLinkAboutBuilding Permit Application AI.I.APPLICABL INFO MUST BE COMPLETED.FOR APPLICATION TO.BE ACCEPTED
Date:: `t I UPerinit.Nuirrber:.. t,G.�_
` - Building Permit Application
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Planning:and Development Services
Building.and:Code Regulation Division
2300 Virginid Avenue,_Fort Pierce FL 34982_
Phone:(772)4524553 Fax:.(772 :462-4578 GOrnmercial Residential:.
PERMIT APPLICATION FOR;
. PRt�1 �-.ED t P , U' ME p T • . .
Address: . ..
Cegaa DeScript�ori:. i 1 L a
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Property Tax ID Lot'.N.o;
Site:Plan Name: . _ Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:.. .
DETi [:�D DESG�tTiO 4F Vlt
c e� .-T ( CQr
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rtrona wor ao e:pertorme, under this permit:;-check,ail Mat apply,
Vmecl anical Gas TankGas:Piping Shutters ? Windows/Doors
Electric —,Plumbing �Sprinklers* _Generator _=Roof
Total.Sq. Ft ofConstruction:�2 5 g Sq: Ft.of First Floor:.
Cost of Construction $_ O . Utilities: Sewer Septic. Building.Height:
Name (f uri Name: tcan
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Address: ( If►GZc'P�i=i'-' �� ' Company: r'
i State: . Address: 5`1 1��'(17et'Cd►nt to '.L
zip,code: -3L � Fax. '^ City
tG{'•E' Stater �1...,
Phone No. L4 C> 15- S" ' . Zip Code: Fax:
cC
E-iVlatl: Phone No.(-
Fill ir
o.(-Fill.ir fee simple T;t1e:Flolder on next page(if different E-lvlaii:. . Com
from the Owner listed aboye} State or County.License: C¢
If value of construction;is 2504 or more,a RECORDED_Notice of Commencement is.:cequired.
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I' DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address c Address:
City: State: City:. State:
f Zip: `Phone: Zip:_ Phone:
FEE.SIMPLE TITLE HOLDER:. _Not Applicable BONDING COMPANY: _Not Applicable
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Name: Name:
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Address: Address:
k City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no_work or installation.has.commenced prior to.the issuance of at permit.
St.Lucie County:makes no representation that is granting a:permit will authorize the permit holder to build the subject structure
i which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
l 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,,l 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 recordedand posted on the jobsite
before the first inspection. if,you intend to obtain financing,consult with lender or an attorney before.
commencing work or recording:yoLIr Notice of Commencement.
Signature Owner/Agent/-Lessee Signature of CapLi Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF IS+ L_u6�e__
The forgoing instr meet was.acknowledged before me The forgg�ing instr ent was acknowledged before me
this)day of 20�by this JLNay of 201Lp by
(Na a of person nowledging) (Name of persqd acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
i Rersonall Known ��ARcgduce-d lclentifio'atfg,
Personally Known „s� QR Pro u a ept ►�gti�gn Y
—� DEBORAH MUSSEL!—
Type of`Identificabbn Qi} nintan�nnli. state of Florida I� Type of Identification Pr duR�, th
Cl; ; a _ _r
Notary Public aTe
01 hol'i
•, , •E My Comm.Expires Nov 30,2018;;. , r
4,,,�hhh�,,,i'\1 U„•_ivty Co.� Aires Nov 30,20118 .^
Commission No `r %_, CommisisSeat);FF 179630 I, Commission No: �a`��
OF Bonded through National Notary Assn. ComisslUn # FF 179630
P;2!on21 P
,ntary..s .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
RECEIVED
DATE: . I
COMPLETED
-R—ev—.7/2014