HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 C- I Y 11 7 Permit Number:
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
PERMIT APPLICATION FOR:rf%IJ� - _ � _ _� U
Address. I U L4? 1x Ai ne_ 1M ee&1.e_ J)ir
Legal Description: _R A1C'_ A�0 � 16 0�3 L ---,V) I
L_ 4-6'
Property,TaxID#:. C,0 - &CP_7 66(5),3
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
LDETAILED DESCRiPT ION OF WORK:
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CONSTRUCTION INFORMATION:
A ition I al work to be performed u6der this permit - check all that appy:
�fVlechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: j
Cost of Construction:
Sq. Ft. of First Floor: —
Utilities: —Sewer —Septic
Lot No. 15
Block No.
Windows/Doors
Roof
Building Height:
OVv NER/LESSEE:
CONTRACTOR:
Name 5� d r'1I.'�
Name: b_M
/�i'
Address: I D Lv- 1'2 10 eeA t e- Vii' .
Company: 6nd.,ll.] P't' I C&b tI /)a
PCl J, A
City: &_'Vc_-� State: FI .
Zip Code: ":�-)LJ'1 i-1 Fax:
Phone No. 2 `7 2 - tL - 1 -31 b _--
Address: . oa �2U _7
City: F "• 01 oxc--e-
Zip Code: 3 L) 1 S Fax:
Phone No - 5-
tQ 7 ` L3
State:
TV - L ' 40f
3 -7'7
E -Mail: NA1-
Fill in fee simple Title Holder on next page ( if different
from the -Owner listed above)
E -Mail ctexn
tD' tad +CzYI')
State or County License Vit.
40- 4R LP41L/
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ ENGINEER:
Name:
Not Applicable pA
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
of Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
-1
(Name of person acknowledging)
Address:
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City:
City:
(Signature of Np a y Pu of Florida* . `� g
Sr�l3lZiK IL.
Zip:. Phone:
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Personally
Personally Known 61--l-'OR Produced IdE$9[it$1Nkxg
Zip: Phone:
Type of Identification �9cA¢ �d� ro� �.� •
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.
fn consideration of the granting of this requested permit, 1 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 nonresidential 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 i pection. If you intend to obtain financing, consult with lender or an attorney before
commencingrk recording our Notice of Commencement.
_Z�oo�� —
of Owner/ Lessee/Agent
� Z" I �,
s- u Contractor/License Holder
F FLORI A
70UNTY[
S E OF FLORID
FLORIDA.
LLA_cr
TyOFj_5�
OUNTY OF C e_
The forgping instrument was acknowledged before me
, , 1%
The for ing instr ei t was acknowledged before me
qday
this day of C� 20 by
this A of ii A21V_ 20_" by
-D—O_Mel�s Jr_,,V
__1 61U4
-1
(Name of person acknowledging)
(Name of person acknowledging)
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a� ���h�4S5lp g;�1LAC�l����i
14 4
(Signature of Np a y Pu of Florida* . `� g
Sr�l3lZiK IL.
; (nature of Notary Public- State of Flo d 4, nary s
_ i �+� frni7
Personally
Personally Known 61--l-'OR Produced IdE$9[it$1Nkxg
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i•U�'a a Q
s ' 4Iy �'n4 3 e�
• onal OR Prod
Type of Identification �9cA¢ �d� ro� �.� •
own uceldriicaffo31 y.
eTWe of Identification s F�1
Produced 'moi G8 ••:�a"d::• o
produced �� °• N 6°nda�O�.6�
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�^rSTATENii
Commission No. —E : 7 3:� (Seal)
q �,A�T4h'y
Commission No. FF l� L 5 33 /(Z94Y)#jn 4;'''"` h
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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