HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 14 Permit Number:
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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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
"PROPOSED.-iMPROVE MtNT'LOCATION
Address: /7]/,J/)y
Legal Description: X-If//•7C e 1-7Z -X 72 Z07 /0 ro
Property Tax ID#: 8go•'i -E01 cw U • CON Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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"DETAIL'ED,DESCRIPTION,sOF WORK
CONSTRUCTION INFO.RMATI.ON -
Additional work to b rtormedun er t is permit-check all tha appy:
HVAC Gas Tank Gas Piping _Shutters E]Windows/Doors
OElectric Plumbing Sprinklers El Generator L]Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Z`f®o Utilities:0Sewer[]Septic Building Height:
OWNER/LESSEE CONTRACTOR r I
Name (r-1 Name:
Address: (oL�t� i✓1✓ X 0-4��,e C7 Company: /esr7iF C6N�iz..c7�e ��' t4.L
City: Stater Address: �;b6> 26 /
Zip Code:_5i(l93 Fax: City: State: �-
Phone No. Zip Code:,j 9517 Fax:
E-Mail: Phone No. '? 7 ZI If(
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: S7 S 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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;SUPPLEMENTAL CONSTRUCTION,LIE'N LAW INFORMATION:`: -.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: ! State:
Zip: Phone: Zip: Phone:
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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 Amiendments.
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 recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA'
COUNTY OF - r o , COUNTY OF I a, r\"rte
The fprgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I�day of 201�_by this day of 1N6V 20 l6—by
(Name of person acknowledging) (Name of person acknowledging)
ply..—
'tSt'griature of Not; Public- tate of Florida) (Si ature of Notary Public-State Flori a)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Pfnduc
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Commission No. tt Sal Commission No. �y
OtpRY nGBi :J I yP *4.. N°/dr SHgyN
LASHAHN Fo• oPc` lb1yC YPUb/. A/N
yµ �Y` mmu Jic State v "„�,,, Bo �ommJ Expires ate ofFf
Y Ce o1 Florida no'e ss/ D ori
Revised 07/15/204;;F� tOp��, Commissionires Dec 20.2018 dlh9h°oFFeQ?p?O�Q
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9 �ationalNota v /NOtar
REVIEWS FRONT ZONING 'SUPE 4%R, PLANS VEGETATION SEA TURTLE GROVE
COUNTER REVIEW REVIEW air REVIEW REVIEW REVIEW �W
DATE _
COMPLETE
INITIALS
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