HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: U-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 ReSideiltial
PERMIT APPLICATION FOR:. To Select1rom dropbox,.click arrow at the end.of line
PROPOSED IMPROVEMENT LOCATION:
Address: -710 0 SeL M 776 ')/j J LA_
Legal Description: !-Q OUB rP�Y` -�vi l - �-� ' So t-o 4S `� 7
Property Tax ID#: 1361- b13 - 0.30J-- 000 -7 Lot No. � ly -7
Site Plan Name: Block No. 1 S0
Project Name: Q 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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A)5rA _.i o-T l aN of 14�A rr; cAiie kuJ)e�s
Syl�lr�2f�.
I'CONSTRUCTION INFORMATION: - �
Additional work toe nertormed under this permit-check a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing OSprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 31 TO Utilities: Sewer❑Septic Building Height:
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OWN ER/LESSEE: CONTRACTOR: IC
Name �� � o I k Lk vid Name: \ qI • c6s
Address: --7/ 00 ' Selects �r, v� Q Company: �.�•\. lr'� CAY\,Q SVluX�5 ,r
City: }. `te\' 2Y-CL_ State:: Address: 00 N I�-eY`Qi�ly�1
Zip Code: '3L- C('51 Fax: City: 5N.- q 11-2 r Q State:
Phone No. 7a�� �3 ' ��5� Zip Code: �L-� e � I Fax: �Z-�q 11-1590
E-Mail: Phone No. -77Z- 79Cf- x.58
Fill in fee simple Title Holder on next page(if different E-Mail:Ay YY%CFI.Y1es VV\ V UEkA0
from the Owner listed above) State or County License: �{
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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`SURPLEMENTAL.CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: J' State:
Zip: Phone: Zip: Phone: i
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: !'
Zip: Phone: Zip: Phone:
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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 anofher 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
commencing work or recording our Notice of Commencement.
0117 s
Signat ufe of Owner/Lessee/Contractor as Agent for Owner Signature of ontractor/License I older
STATE OF FLORIDA c9 STATE OF FLORIDA
COUNTY OF COUNTYOF
The forgoing instrument pas acknowledged before me The forgoing instrument was acknowledged before me
thiso'�A 0 day of 20 _by thisa0 day of f 20 by
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(Name of erson acknowledging) (Name of person acknowledging l)
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(S gna a of Notary Public-&1ate of Florida) (Sign e otary Public-&6 of Florida)
PersonallyKnow OR Produced Identification Personally Known OR Produced Identification
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Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. I (Seal)
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Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 'SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE j
INITIALS
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