HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 a.�a.� \� Permit Number:
LAILASUARI-01111111- RECEIV-71) DEC 0 2 Z01g
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: /Z�7-���„�
Address: AaC-hh
Legal Description:
Property Tax ID#: .3y 02 —Z 0 q- a 3 e, y a .0 o Lot No. C�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be perrormea under t is permit—c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
0--c."Cost of Construction:$� 0"0 0 � Utilities: _Sewer _Septic Building Height:
Name Name: n3G0 t-7 - P-, 1
Address: J Company:A// tNd-i" /✓� -�
City: f- P State:_ Address: d 514) 14)-,Ile-0 5,0
Zip Code: Fax: City: _96�'-(—5� 1. LA_C-1 -e State: �(
Phone No. J� 3 7 Pi Zip Code:73 Fax:
E-Mail: Phone No 72_-,2 Jd Sys
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 3
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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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 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.
Sig ature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORT
COUNTY OF - 1.yc COUNTY OF � CU Cd P
The forgoing instrument was acknowledged before me The forgoing instrumgnt was acknowledged before me
this_Q,__day of QQ C 20by this day of 1VQV 20by
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(Name of person acknowledging) (Name of person acknow dging)
(Signature of Notary blic-State of Florida) (Signa of 9t-dry Public-St to f -lora
,,�µY CASEY D FRENCH
Personally Known OR Produced Identification Personally Known OR r- o e QntiifitCa gohlic-State of F' ida
Type of Identification Produced L Type of Identification Produce u x fres Dec 1, 17
NptAAR `F ;r° °o` Commission# FF 069 .
,.„ ,ti, DEAN SSION 11 GG U�023 '%;F oc Fto
Commission No. My( AWi} 16,2020 Commission No. �S�hpedThrough Nationa Noi ssit.
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW;;!
DATE
RECEIVED
DATE
COMPLETED