HomeMy WebLinkAboutaustin permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION.
Address:I' i �' z r'�1 C -7 -
Legal Descriptions:
Property Tax ID #: 4 —Q 030 Lot No.
Site Plan Name:
Project Name: . f `� i M
Setbacks Front Sack: Right Side: Left Side.
Stock No.
DETAILED? DESCRIPTION OF WORK:
K1 i 'HEnJ- PEL_0c4T6 P -ECP >�L-�eS -int, r-4�1-177AAS, � �- E�c�c�9rE vf{7'
p�� _0C4 r E kECEPir- LZ 619 - kf- Ofd ; E Z '6� A) E , ,�; �' ,
CONSTRUCTION INFORMATION:
Additional work to be erforme under this permit -- c ec a appy:
HVAC 11 Gas Tank OGas Piping 1:1Shutters F]Windows/Doors
Electric F]Plumbing 1:1Sprinklers 1:1 Generator O Roof
Total Sq. Ft of Construction:
Cost of Construction: $ —
Sq. Ft. of First Floor.
Utilities: OSewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i it ar/l ADfh%j� �'
Name: AK -1906, 9 6i' (_M11 --A1
Address: 77 A/LV i? illi (21
Company: 4aXA rF_ f V a'RE1i�N6 It1
City: L1-1 Ca jY Stater -
�
Address: -719-3 6t)0o1l 1 Pt_
City: Rdt�'l _,;- I-ort6 State: Ft-
LPhone
Zip Code- 3+110 Fax:
PhoneNo. 5(0 i _ -r
zip code: 3 gi5a Fax:
E -Mail:
Phone No. 771 3'70 -5-7,55
E -Mail: D CV"AJ C @� It -17" ►SET
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: j.0 CUO 30- �
It value of construction is X2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 Count, 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 fall 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 inspecc_U�1ppn. If you intend to obtain financing, consult with lender or an attorney before
commeotinR work of r,6cordine Wour Notice of Commencement. ,
Rev. 7/)-U:.4
Sig ture of Ow r/ Agent/ i.essee
Signature of Con ctor/E icense Hol er
STATE OF �ORIDAa�
STATE OF FLORIDA
COUNTY OF
COUNTY OF'ZZA-
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this W day of _2',L� , 20LZ by
this 6�_ day of , 20/ by
`
(Name of person ack ledging )
(Name ofperson actino dging )
n
(Signature of Notary Publi tate of Florida }
(Signature of Notary Public- to of Florida
I
Personally Known /?(, OR Produced,k"M ft fin
Personally Known ,Olt Produced identification
Type of Identification Produced � E C. Ill ��/o
Type of Identification Produced 1111111IIli�t�
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Commission No,
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Commission No. %bS'l '�
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DATE
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RECEIVED
DATE
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