HomeMy WebLinkAboutRevisions All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d' oL - Permit Number:
0311*1
- CEIVED
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XV
Planning and Development Servic s OCT 2 4 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982pe 8 ent
Per. ittin p
Phone: (772)462-1553 Fax: (772)462-1578 Commercial FL
PERMIT APPLICATION FOR: � hCe
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Address: 401 �S�i t1� !rT
Legal Description:
PropertyTaxlD#: 3"1d"�" 6G��- dad^a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed uncier t is permit—check all that 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 Construction:$ I�(00 610-0 Utilities: —Sewer —Septic Building Height:
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Name I Name:
Address: of 1&4 Company:
City: `PIi�rGt State:_ Address: 0/ �4ii re'c� 1-
Zip Code:!3ggf? Fax: City: � 4D e-�C e State:
Phone No. 6W IS'? Zip Code: !3"f2- Fax:
E-Mail: Q v dr 1'0 Q rn'O • Com) Phone No 461 Z —,57370—
V
Fill in fee simple itle Holder on next page(if different E-Mail aa— G 6J • GW09
from the Owner listed above) State or County License D
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
CQNS KI-1 TIQNy:I ISI I /�C Q MATE } � .�"u� wT�
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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 TkTL••E HOLDER: =Not Applicable, BONDING COMPANY: _Not Applicable
Name: Name:
Address:'": i "? 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 poste 6qqPthe jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an or dy before
commencin rk or rec din our Notice of Commencement.
Signature Own r/Lessee/Contractor as Agent for Owner Signature of Co ractor ' ense Holder
STATE OF FLORIDA :STATE OF FLORIA
COUNTY OF �5 VOc.t COUNTY OF S �-y L`4
The forgoing instrument was acknowledgeAbefore me The forgoing instrument was acknowledged before me
W'\ �G'�+
this day of 20 by this'_day of ZSR 20LI_ by.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identification Personally Know <Y°w'•.lJR Pi-859W n
Type of Identification Type of Identifica @�i MYCOulMISSioN 1
a, EXPIRES:December 16,2020
Produced V, l NAMARIEGNENS Produced , ubGeundenw'tets
.-W,
C.. M SSION GG 022023
Commission No. (PIR F0r=,ber16,2020 Commission No. 5 (Seal)
BondedThnIMolPubllcUndenvriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
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