HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED:
Date: Permit Number: l 1
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-- Building Permit.Application' SEP 01 2(17
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Planning:and Development Services PERjAITTING-'
Building and Code Regulation Division St.Lucie County,FL"' '
2300 YlTinia Avenue,Fort Pierce FL-34982
Phone:1772)46-2-1553 Fax:J772)462-1578. Commercial-_ V1_ .Residential.-
PERMIT APPLICATION-FOR:
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Address:" 6a'W f i. POIt i.i1 C1) F 8(49_4,�I� ;
Legal Description: IT tng—"._
Property Tax ID.#:' .. S?O S.66_4 1 bn Lot No.
Site Plan:Name: 4 BlockNo.
Project Name: -
Setbacks Front Back: Right Side: Left Side:.
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i rtiona wor to a pe orme un er t is permit-cneCK all tat appy:
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 Constructions'$ .�02�,6S Utilities: —Sewer —Septic Building Height:
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A RSSE� CANT C"("O .
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Name j M IRA 6z L P.
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Address:��t-j� b:4 M ftI d ST Company: e4 S C,9 4j2 ._
City:-311 ,1 aA'I-.,o State: Address: ._.-_�..�.�f_._..Ll
Zip Godei 1 LfQ-P/A_ Fax: Ciity. 1�J7"0� (',/�1 State:FL
Phone.N6. Zip Coder 33 � Fax:
E-Mail:' Phone No S�b I - MA f-13 � D
Fill in fee simple Title Holder on next page if different _ E-Mail Q.?AQj)(it,y3o0 C9 Mstly:60r%vj
from the Owner listed above) State or County License n-A C_ V%1. 12211.V 3_
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 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,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 firs pection. If you intend to obtain financing,consult-with lender or an attorney before
commencirig iWrkor recordiDg your Notice of Commencement-:".
-Signature of. r ssee/Contractor as Agent for Owner SI natur of ont or/Lice se Holder
STATE.0KFLORIDA ST FLORIDA 1 ,
COUNTY OF COUNTY OF 1.�J
The forgoing instru _ent w s acknowledPP before me The forgoing instr ment w s acknowledge�efore me
this day of 201 by this day of 20 'l by
k:04goc., bf(,�, %I�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
..'Type of Identific on yy�-� Type of Identifi n
ProducedL Produced r �•
` lis S. NIELSEN ' ,.��.,
Commission No. �,:� � sion S FF 115637 ommission No. � o %; .�(WN S. NIELSEN
_� *_ orrimission q FF 11563
My Commission Expires -
�,� My Commission Expire1-2 9nis
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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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