HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: Permit Number:
_ Building Permit Application FEB /3 2017
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 —Lz
PERMIT APPLICATION FOR:
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Address: lowen S, Oce l > <;P� { FL �, 1-#so Ce
Legal Description:
Property Tax ID#: -1-5
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Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESC 1PTI®N a WORK"ON4 }}
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ACIClitional worK to be pertormed uncler this permit:-check all that appy: r
_Mechanical' 'GasTank _`Gas Piping _Shutters Windows/Doors.
(,Electric _Plumbing _Sprinklers _Generator — Roof
Total Sq. Ft of Construction: //o o. Sq. Ft. of First Floor:
Cost of Construction: $ /dam 0 0 Utilities: ..—Sewer' _Septic Building Height:
OWNER/LESS€E. ICON TRACTOR r • 3
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NameFjrNeS'T- ,SP°rOTR7 Name: /ZA,v aLL '.-4
Address: 103o( ;fig eaar.� ow- u.►j+rt-# sa C- LC-C
City: is- I State f 1. Address: /b 3oa S• /�Z7y Es,( N!tu� �vi,
Zip Code: 34a s Fax: City: P-S- L State:-F-L
Phone No. $IS' yaQ - C,d-I I Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail �i�tf"v � ac) I,arsa.( QLe(ij�d`cr r-�)kvi
from the Owner listed above) State or County License C/y
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJRPLE�IUIENTALC®IVSTRUCTIQN 1:1EN ��,'°W I FOR�I�IATIh®N: .
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,fence+s,'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.
Signature of Owner/L Contractor as Agent for Owner Signature of Contractor/ ' e'Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF COUNTY OF
The f rgoing instr . n was acknowledge before me The going instru t as acknowledg efore me
thisL day of � 2013 by this day of 20� y
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(Natne cif person ackn wl ging) (Name o person ackno ledging)
IVA �Ld
((Signature of N ary Public-State of F ori a ) (Signature f,lYa ky%pubIii c-
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Notary DELA M HU
y Publi FF
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Personally Known OR Produced Identification Personally 9 c C9gdblrlst%a on
Type of Identifi 'o Type of Id nti °(ANY om t ° FF 234730
Produced pMGELA.M HUFF Produced' � �� one o'Ex i s May 27,2010 y
,.j ��avP� oaryAssn
o`" �; Notary Public' state of Florida R
Commission No. C65er i4sion#FF 234730 Commission No. (Seal)
My Comm.Expires May 27,201 ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 4