HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED
Date: 2— —�7 Permit Number: ', 111-1(11�),- 0�1-s )
. _ 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: f
Pr�'�OIi- i"Oh
PROPO•SEDINPROVEMEpNT LOCATIC►N
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Address: .070/ S OCeew, Dr. ;0 ?0)? ;jL/JSd4 BeacX , A/-J 3yy5'7
Legal Description: LAM kre 04,� 0t .LiaA/G✓� �i ✓�Pr h 'b'F
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Property Tax ID#: Y5,// 6/0- 000(7 "900 Lot No. 1?08
Site Plan Name: �E����e Block No.
Project Name: 707
Setbacks Front Back: Right Side: Left Side:
DETAILED DhESCRIPTION OF WORK :
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Co M le Ie BmahiA'-ah 41Oldvo/ 0f M0J; �i¢r�t (6A) s • �l 4,0of
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Additionalworkto a performed under this permit-check a that
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appy:
_Mechanical _Gas Tank _Gas Piping _ShuttersI _Windows/Doors
_Electric _Plumbing Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction: $ 1709.06 Utilities: /Sewer _Septic Building Height: (� f
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�OV1lNERjLESS �E „ ti CONTRACTOR `� rk
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Name Ai %1 S 0�- ori/ E/ '7 Vaa's Name: ��,,rirr�
Address: �0� dei sD�a.i �� Com pa ny:/t�,��).,1 80JI:�Aj7f' 5k inC.
City: Aun4 4aW&"A State:AIY Address: al 1�E .37--Aee.- 51.
Zip Code: 0,10570 Fax: City: Je"?'ren is .d to o/i State: Rl-.
Phone No. 609 709-3/,25- Zip Code: 3Y95 7 Fax: 772-)-3.2'��9/
E-Mail: Phone No 77), ` Z60 - 3, 7/r
Fill in fee simple Title Holder on next page (if different E-Mail a 4(rwM ISM i7,,-,6 1'4C (.D- )/4490 . Cain
;
from the Owner listed above) State or County License 'GRC /12 5,/90?/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5UPPlEMENTAL CO`NSTRUCTtON LIEN LAW INFORMATtO,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 thepermit 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 r Notice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this(R-'J., day of `��o .2o n by this cSK day of 1r—Z_3, 20—a by
a&u_N-" . l 'KAWIl %ak
(Name of person acknowledging) (Name of person acknowledging)
&av,o.�N� � �Q�.
ignature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identifications Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
5 30• v12 �1• IIo�.O s��;01-L- 11- Itoy,Q)
Commission No. ,.,� I� LASHAHNA I mis n No. (Seal)
ti =a°o ;`�l: Notary Public-St to of Florida
%9� Commission FF 177249 "'� '�. LASHAHNA INGRAM
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REVIEWS FRONT ZONING,"� SUPERVISOR' •'!PLANS,, VEGETATION � � LElota ylC6AWG*9IIz�V�Flo id
COUNTER REVIEW REVIEW REVIEW REVIEW , MyC mmFfEV1i;sWec20, of
-Ca naussion FF it 724 9
DATE �':'F°F F`°4'�� Bande through National Notary Ass ii
RECEIVED r
DATE
COMPLETED
ev.7/2014