HomeMy WebLinkAboutBuilding Permit Application (2) i
ALL APPLICABLE INFO MUST:BE COMPLETED FOR APPLICATION-TO BE ACCEPTED y
Date: 04. 2, Z01' Permit Number:
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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 �
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'PERMIT APPLICATION FOR: To Select.from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION,-
Add reSS:
OCATION:Address: l (0 1 Z (6g o L`W D o Gil x-1'1 , t� (PJ"CsL� 1�: — '�jf�
Legal Description: ( oy�r �y-�4 NXAVI C!:� CU-�� �vlt'16 .9 hV-e -� qg
( o 6Z [-1 3 S_- ate-7)
Property Tax ID#: I Z2,90 - I-70 / - 004 - 000 - '? Lot No. 418
Site Plan Name: LLI\ CK01— Block No.
Project Name:
ovQ
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Setbacks Front Back: Right Side: Left Side:
,DETAILED DESCRIPTION OF WORK:
__T: N S T A is LIr-r-N oN
iN(2C_o d2 D t O r\) S AL&-�T✓eS •— Two (—z)
J�Gco �!Z D i e tV r�� rS — Fi Ve L s� Lr✓�T- S i��
.CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy: i.
HVAC E]Gas Tank []Gas Piping Shutters D Windows/Doors
11 Electric El Plumbing []:Sprinklers ElGenerator E Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
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:OWNER'/LESSEE: CONTRACTOR f
Name I"\&Y-i�_ Name: i r rTm Q X5-8 _
Address: I Z l�moo( c,�o oG� Company: ��•T �v��ri cA2 hc,,��R 1-
City: -• State: I:;( - Address: \Q 0!
Zip Code: _5LI95( Fax: City: rc_c- State ��-
Phone No. -17 2- 2- to — 75 3 Z Zip Code: -Vy�S 1 Fax:, -772-79Y-I S4D
E-Mail: Phone No. —7-72-- 719q— /SR)
Fill in fee simple Title Holder on next page(if different E-Mail: w}kUrr t'Cp,vim
from the Owner listed above) State or County License: L)Jq�
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPFLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION: ! `
PP —Not Applicable
DESIGNER/ENGINEER: _Not A licable
MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 respect's,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments:
lThe 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 our Notice of Commencement.
A L�IL lZi A 1), LAU,?-)
Siin5turq of Owner/Lessee/Contractor as Agent for Owner tur of Contractor/License Holder
STATE OF FLORIDA \- STATE OF FLORIDA \
COUNTY OF 11��.r¢r.sz, COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instru ent as acknowledged before me
this day of 20q by this day of _ ,20 )by
Name of person n making statement Name of person ma ang statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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Sign ture f Notary Public-State f Florida) natu of Notary Public-State lorida)
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Commission No. LASHAHNA ING A�bmmi ion No. d'""'�. ' AHNA INGRAM
��""• State 1 Florida e
0,PaY Pue`"'a Notary public' 'r°* .'�'.; Notary Public-State of Florid
pins De 20.2018 _•« :•e My Comm.Expires Dec 20,201
.:MY Comm.Ex
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I Notary Ass.l ,,, ,.���
REVIEWS FRONT oo3op '--',PLANS VEGETATIO thrM
Goj�/EAss
COUNTER I W REVIEW REVIEW REVIEW IE
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17