HomeMy WebLinkAboutBuilding Permit Application OCT-11-2011 WED 03;33 PM CENTRAL SCHEDULING FAX No, 3'212686138 P, 002
ALL APPLIC SLE 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 PL 34982 -
Phone:(772)462-1553 Fax: (772)462-157$ Commercial RESIC(Entlal ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 0, b ��
Legal Descripp+tio 66 1,U \�) e�
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Property Tax ID - rot No,
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Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional worko e e orme under is permit—checka appy:
HVAC Gas Tank E]Gas Piping _Shutters a wlndows/Doors ,
�I Electric 0 Plumbing O5prinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities: . Sewer[]Septic Building Height:
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Namejy=Q Yna Name: C
Address � Company Y
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City:Y i�► �� C� __ State: Address:
Fax
Zip Cade �� ' City Y ��
QState:
Phone No. - k Zip Code: 54q9LO Fax: A o
E-Mail: Phone No, ` 2MC)
Fill in fee simple Title Holder on next page(if different E-Mail: wal CON
from the Owner listed above) State or County License:0K
if value of construction is$2500 or more,a RECORD90 Notice of Commencement is required.;
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OCT-11-2011 WED 03: 34 PV CENTRAL SCHEDULING FAX No. 3,212686;138 P- 003
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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
Narne., 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 Oran covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for!iariy restrictions which may apply,
- I
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 appilcation5 are exempt from undergoing a full concurrency review:;room Additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory juses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of'Commencernent may result
t in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and poked on the jobsite
before the first inspection. if you intend to obtain financing,consult with!lender,or an attorney before
commencing work or recording your Notice of Commencement.
Signature of ner Lessee/Contractor as Agent for Owner Signature of Codc tor/Liceiise Holder
STATE OF FLO IDA<::)-\ STATE or FLORIDA
COUNTY OF COUNTY OF
The fa oinglnstr t owledged before me The fqqoing instru ent was acknowledged before me
this —T day Of by th,i/_ day of. 20 VA by
Name of pers95 making statement Name of person making tatement
Personally Known ' — OR Produced Identification Personally Known-.V- OR Produced identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- t (Signature of Notary Public-iSt qt,Florlda
'9JOq6heflne Konger 6y"P
Catherine Konger
001717172372
Commission N Commission No. loii#FF172372
BONDED
OCT 28,2018 28,2018
THRU
ONDEDHRU
IST FLORIDA NOT=LLC "A-4;w" IST FL9URIDA NOTTMY LLG
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17