HomeMy WebLinkAboutBuilding Permit Application From:Holly Kulinski Fax:(800)757-0066 To: Fax: +1 (772)4621578 Page 3 of 5 '1111712016 2:44 PM
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:IN 11_1A I,
Permit Number:
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Building Permit Application. Nov � � ���
Planning and Development Services
Building and Code Regulation Division F c r(di l i Ml2300 Virginia Avenue,Fort Pierce FL 34982 / IG
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential. j` St. Lucie County, FL
PERM IT APPLICATION FOR: To Select from dropbox,click arrow at the end of line I
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Address: 5n -
LegalDescription:
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Property Tax ID A: t / - 1
Lot No. 1
Site Plan Name: Block No,
Project Name: y
Setbacks Front Back: Right Side: Left Side:
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Total Sq.Ft of Construction: _ 5Ft.of First Floor:
Cost of Construction:$
_ ) Utilities: . Sewer05eptic Building Height:
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Name
Name:
Address: J
— CompanY; t
City; 1' Stater Address, ?ayCt C
Zip.Code-. Fax: City; ag,k'PtLc v State:
Phone No. 111v)
Zip Code:r,�io,�. Fax:"M-ancl, 6
E-Mail: Phone No.
Fill in fee simple Title Holder an next page(if different E-Mail:
License;
from the Owner listed above) I State or County _
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if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
From:Holly Kulinski Fax:(800)767-0066 To:
Fax: +1(772)4621678 Page 4 of 5 111170016 2:44 PM
DESIGNER/ENGINEER: Not Applicable R CAGE COMPANY pt_c Not Applicable
Name: 7k Name:
Address: Address:
City: State: City: 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:
I certify that no work or installation has commenced priorto 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 consutt with your Horne 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 1 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 ork or recording our Notice of Commencement.
s
Sig ature of Owner/L ssee Contractor as Agent for Owner sigstaturs,of Contractor/ticens Holder
STATE OF FLORIDA STATE OF FLORIDA
COLINTY OF �.l,s _. COUNTY OF,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,°�day of t�3 t1E m om' 20 94-by this 1') day of 20 tl4 by
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(Name of person acknowledging) (Name of person acknowledging)
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(Slgnat of Notary Public State of Florida) (Signature&fNotary Public-State of Florida)
Personally Known OR Produced Identification Personally Known�j OR Produced identification
'Type of Identificatio Produced Type of Identification Produced
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Commission No. ( Iib 061MI9SIONffiFF142132 Commission No_Fr-Nov�. �" (4gy�(OMld155.{(X1tFftd2732
EfPIAES:August 5,2U18 EXPIRES:twgii515,2016
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Revised 07/1,5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS i VEGETATION f 5EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
? DATE
COMPLETE #
INITIALS � I