HomeMy WebLinkAboutBuilding Permit Application 'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�, Permit Number:
4-
W. I -- 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: �. 2. 1'1-l..�m l �. �ia 11 ��Y "� J a t ni L tA r i e— ('"�.—
Legal Description: I V-P �Di Y K �i(.Y11 -� 1 K �2 10
Property Tax ID#:3LA 1(2i 1 Q 03 2 q- C)QQ 3 Lot No. 12.
Site Plan Name: Block No.
Project Name: 15 01 d i �
Setbacks .Front Back: Right Side: Left Side:
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�t�ona wor to e e orme un er t �s permit—c ec a appy: �
HVAC �Gas Tank ❑Gas Piping _Shutters WindowsJDoors
Electric um ng Sprinklers Generator Roof
Total Sq. Ft.of Construction: Sq. Ft.of First Fioor•I
-73
Cost of Coristruction:$ l��� • Utilities: Sewer Septic Building Height:
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Name DOr-mj r) t c K , SC) I(I i Name:1 Jpj AMe-es, fy� Q
Address: 2 12 12 rn i e LaKNAL Company of
City:2b r t- ; ri i 1k C e—State:ELL Address: !�?,k� tom" 7� LH
Zip Code: ' 1r�1�v- Z Fax City:� knti t _` C nl�,_ State: F ---
Phone No.1-79- T-73 -2-0-17 Zip COde:3SLl 1 9-- i Fax: 5-L.,I .`a S--4f41(,)t�
E-Mail: Phone No. C�l
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: .
I
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. f
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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 ofa=permit.
St.Lucie County makes no representation that is granting a permit will autihorize 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
commencing work or recordinp,your Notice of Commencement.
signature of Owner/Lessee/Agent Sighature:of Contractor/License Holder
STATE OF FLOBIpA[kAL`e COUNTY OFSTATE OF ORMaitwi y !
COUNTY OF �}- _ �P lam(,
The fQsgoing instr e t was cknowledged before me The forgoing instrume t was acknowledge before me
this l�`==tt day of 20by this day of 0C� .20 by
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vyi�� lin l
(Name of person acknowledging) (Name of per n ackniwledging)
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(Sign ! No arytake of Florida) x (Signature Notary Public-Sate of Florida)
Personally Known OR Proed Identification / Personally Known OR Produced Identification
Type of Identification Produced Pi D Type of Identification Produced
TIFFANY NES o�PRY P�BIi ANGELAYOUNG
n
Commission No. TARY C Commission No. = MYCJ8eat)ON#FF951069
N� CQ EXPIRES:ApbI 12,2020
STATE OF FLORIDA Bonded Thru Budget Notary Services
4M
Cara*FF967191
Revised 07/15/20• Expires 3/2/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE`
=INITIALS I