HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 'l
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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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end;of line
PROPOSED-IMMITROVEIVIENT LOCATION:'', �.� ': .. Jl
Address: !
Legal Description: n;(�5 k-9 T Gl 1 rtocl r S I W� I
Property Tax ID#: IyVt[�—' �� 00.75- CDa'3 ! Lot No. —7
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: .
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DETAILED DESCRIPTION,OF WORK:
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CONSTRUCTION INFORMATION.
AdditionaloworK toe performed under this permit—checkkall appy:
HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 4-753
Utilities: Sewer 11 Septic 'Building Height:
OUVNER/LESSEE: ;.,.CONTRACTOR l-,
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Name 1� Name:
Address: Company: SCYVICe i ArneriCq
.0�55.NU) 63rd
City: C� State:� Address•
Zip Code: —�1 Fax: City: ucl r Ad l State:'F-1
Phone No. / /Z^ 1"— '1'0Z7 Zip Code:�J�+ Fax: 5���yy `7 �7�35q/
E-Mail: Phone Nvvrni7i,
7 "4100 EX 7
Fill in fee simple Title Holder on next page(if different E-Mail: 1'QU V ICI!11QA'ICQ
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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SUPPLEMENTALCONSTRU'CTION LIEN LAW INFORMATION: a
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: i Not Applicable
Name: Name:
Address: Address:
City: City: I
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,
ac a sory structures,swimming pools,fences,wall s, s,screen oms and accessory uses to another non-residential use
W R ING OWN ,:Your failure to Record a Noti o C encement may result in your paying twice for
im ro em nts o your roperty. A Notice of Commend n ust be recorded and posted on the jobsite
bef �� the first specti n. If you intend to obtain finan,'n on ult with lender or'an attorney before
com ncl k or r ording your Notice of Comm n
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Signatu I
of 0 er/L ssee/Contractor ds',Agentfol= wner:OSig a ure of Contractor/L4cense';Ho der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF r3Q-C_,,f\-�'� COUNTY OF R0eJC! -e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisll day of 0C_—Tc:6E _ 20 1_ by this_Ll_day of 0�-F06S,2 J 20 by
K +n1 �t��ra-i Toq u
(Name of pers n acknowledging) (Name person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Not ry Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced!
Kerry Ann Baychu ' 1
Commission No. o otaryPiiOWatateofFlorida Commission No. µYP C Kerry�tYNCychu
Comi:iirssion#GG 33869 _ ��. NotaryPublic-StateofFlorida
FOFFt° sr r Expires 9127/2020
Revised 07/15/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS i
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