HomeMy WebLinkAboutBuilding Permit Application JAN-12-2018 FRI 08 58 AM CENTRAL SCHEDULING FAX No. 3212686138 P. 002
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11� Permit Number:)J(3 I-day
Building Permit Application RECEIVED
Planning and Development Services JAN 1 2 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Plerce FL 34982 i Co ty, perminIng
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Re '
PERM IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v ��
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Address:Address,uii oo1i n I ac e
Legal Description: 15h ge�
Property Tax I 13�� 1 t - Odd 'O `4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Htuna wor to e e orme un erthis permi —c ec a apply.
VAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing 05prinklers Generator Roof Roof pitch
Total Sq.Ft of Construction:
{ SIC Ft.of First Floor:
Cost of Construction:$J. V� Utilities: Sewer E]Septic Building Height:
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Name We, Win Name:
Address: Company: _
City: State:Z Addr
Zip Coder Fax: City: S.taate.
Phone No. Zip Code: Fax: ��Z (���-5090
E-Mail: Phone N9, '
Fill in fee simple Title Halder on next page(if different E-Mail: Qr C
from the Owner listed above) State or County icense: I�LF
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
JAN-12-2018 FRI 08: 58 AM CENTRAL SCHEDULING FAX No, 3212686138 P- 003
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: r 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:
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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 ermit holder to build the subject structure
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which is n conflict with any applicable Home Owners Association rules,bylaws or an9covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may appiy.
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
1 4
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 your Notice of Commencement.
Signature f ner/Lessee/Contractor as Agent for owner Signature of ctor/Lic@nse Holder
STATE 0 FLORIDA STATE OF F RIDA
COUNTY OF 3� - COUNTY OF
The fring instru ntwas icknowled fore me Thef Ing instrument was acknowledgf�before me
_day of 11LAC10 3 eteo this day 20 by
this 3% y
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Name of person making statement Name of making statement
Personally Known V, OR Produced Identification Personally Known OR Produced identification
Type of ldentlficatlon Type of Identification
Produced Produced
(Signature of Notary �Jor (Signature of Notary Public-Si to Florida
Pu Il
c- KDnger Catherine Xonger
C�dCommission N 00 PF172372 Commission N tC**i0n#FF172372
Expires;DCr 28,2018
BONDEDTHRU 13CINVEDTHRU
xyr FLORIDA NOTARY LLC 15T FLO R1111A NOTARY,t.LC
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.$/2/17