HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J
Date: S !Q ) 1 Permit Number:
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RECEIVED MAY 2 6 2017
v 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:
}PROPQSE® INPy�ROUEMEI�T�LOCATION
Y SyY9�""` 415 MEi71.491�'i 9�. .Ibvr �xw 9t si S.
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Legal Description:5)0 :25A 46 5 ZOO
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Property Tax ID#: I p — \\ --c tQ2 Cin -- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D TAILED DES:CRIPTInN QF
YNy,
��CONS$TRIJCTIO'N INFORMATIQN � * dam
Additional work to be pertormed under this permit—c ec all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructi n: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer Septic Building Height:
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O�WNeERLEssE'E�:. r 4y N0 TAC "OR':
Name5 'o4'l1LL r_>j Name: QCs e
Address: -..5 . Z��, 3f?ORirM�� Company: 4QPc 00 c
City: State: Address: - 8/ ti�tq►�
Zip Code: Fax: City: � . �f 3y5— State:
Phone No. / 772 — 40 Z ' Z3S�— Zip Code: ?4 11 Fax: 45r
E-Mail: Phone No 77Z'411et T?41
Fill in fee simple Title Holder on next page (if different E-Mail CEJ Z
from the Owner listed above) State ountyLicense106
14 11112
If value of construction is 2500 or more,a COR D t e of Commencement is required.
SUP'P"L:EM:ENTAL CONSTR'U�TIiPr, N L11EN LAW INFOIRRM7. [ON:
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 o.f 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 lend e r an attorney before
commencin w k or recording our N tice f Commencement.
X
Signatare a'Orre essee%Contra for as Agent for Owger Signa o Factor/License Holder _
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF • L�ca-C—
The for ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �l 2011 by this�day of 20f7by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of otary Public-State of Florida)
Personally Known v Personally Known OR Produced Identificati7FF ,Type of Identificati R '" ICAf3YN Cs®� Type of Identification KM G p
Produced -•. °ii MY COMMISSION#FF198558 Produced :'�
(FIRES February 11.2019 MISSIO
• EXPIRES gbruCommission No. Commission No.rr< <� . '•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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