HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETES)FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 114 d3��
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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 IMPROVEMENT.LOCATION:
Address:41 E%Y'Q (a Yl La In e; Fort F I e rcc,F L S4982—
Legal
4982—
Legal Description:ka�ry l Uj ro Ve SID IU �, H __Q I 10 0.11 ( UP. 30 5—
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Property Tax ID#: - 5113-=0_00,11 Lot No. 0
Site Plan Name: Block No. -�
Project Name: ISI C C 0yl Kt C 1 d-e ri C e
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.. Q OF
aroFf on-e ISI tv ol= txIS npsi l�s� alfi hingQJ down w etWing Sluotrhln boards.
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CONSTRUCTION INFORMATION:
itiona work toe e orme under this permit-check a appy:
HVAC 11 Gas Tank FGas Piping _Shutters E]Windows/Doors
OElectric ElPlumbing Sprinklers 0 Generator 12 Roof Roof pitch
Total Sq. Ft of Construction: I i L4150 S Ft.of First Floor:
Cost of Construction:$ d Utilities:Sewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name r Name: P l
Address: Company: M-(Aff rl)
City: State:FL Address: i01 S�,�TftlalI� blvd
Zip Code: cl8 2 Fax: City: fare State:.
Phone No. C-1-1 20 2 11' QJ(A Zip Code: 76490(4 Fax: L-1-12) 2310
E-Mail: Phone No. 112 2_8(o- $Mg I
Fill
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Fill in fee simple Title Holder on next page(if different E-Mail: I( F n o
from the Owner listed above) State or Countylicense: CCC,II 3 Z�a-1-I 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN`LAWWFORMATION:
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 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.
/ s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_- COUNTY OF M A 12-11
The forgoing instrument was acknowledged-before me The-forgoing-instrument-was acknowledged before-me
this day of . 20 by thisjOLdayof 1 ' ,20 �by
RI014rd S07-t ''
(Name of person acknowledging) (Name of person acknowledging)
OJ)dXCA O
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification-Produced Type of Identification Produced EL ID
Commission No. (Seal) Commission No. Fr It 00 2-5 - al)
ALEXANDRA N.DEMAY0
25
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° Expires August 4,2018
Revised 07/15/2014 `i M ` �� � •'}�r
Boded Tluu Troy FainInswaeae 800.385-1019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS