HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED }�(
Date: 9 . 1� Permit Number: I ��
RECEIVEDBuilding Permit Application SEP 0`1 2Q91
Planning and Development Services PERMITTING
Building and Code Regulation Division s;. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:1772)462-1553 Fax:(772)462-1578 Commercial _ Residential r
PERMIT APPLICATION FOR:
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Address: 101`a S JS- a- 1 0j4 W A-i ?011 S'A1&1'I- (AMi E
Legal Description: O l T A .1(0
Property Tax ID#: 3 't S7opq_ I to in Lot'No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
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Add
it/lona wor to a pe orme under this permit-'c ec a tat apply:
a/Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:-$ 2 aa g, %N Utilities: _Sewer _Septic Building Height:
n+ nm
Name �i 2A CSG Lt?_ Name: �1-IAiJGS0 A-- DAt�'tzzl
Address:_ M i a ST•. Company: tAJ C 4i1Z,
City: % '!GALA) State:. Address:._:_.-. 3.q, ------ LAC It(1, ZOL
Zip Code: 1 Lf Fax: City: S�a4j -M-J ' ZW- ,M- —state:Ft
Phone No. Zip Code: 3 W'-.) G fax:
E-Mail: Phone No ( - X 43 Q D
Fill in fee simple Title Holder on next page(.if different E-Mail-0-44 CuA1;t g3e0 Q 6 lnow/y, fir,2
from the Owner listed above) State or County License CAG.V%4- i_-�___:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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 n.o.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.-Plea"se 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 1 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 firslAnpection. If you intend to obtain financing,consy.lt-with lender or an attorney before
commenciMg V/org or recordigg your Notice of Commencemen ' 1
Signature of r ssee/Contractor as Agent for Owner S n aw e4k.of ont or/Lice se Holder
STATE.Ot FLORIDA ST FLORIDA 1 .
COUNTY OF I COUNTY OF
The forgoing instru ent w s acknowled before me- The forgoing instr ment w s acknowledge efore me
this day of 20 by this_L_day of 20Lrby
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(Name of person acknowledging) (Name of person acknowledging)
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(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 IdentifigionType of Identifi n
Produced L D•L Produced �.• �• �-'
N S. NIELSEN c �-,,
Commission No. ,-, � . ommission No.r `.i 5 0 --, .�( ) N,S. NIELSEN
C sion 11 FF 115637 r� �? ommission# FF 11563
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z;- My Commission Expires ,�
;�,,fo `o�a,�e M.y Commission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED'
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