HomeMy WebLinkAboutBuilding Permit Application ALLAPP ALBLEINFT
�11 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Buildihg Permit Application
planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34992
-1553 Fax:(772)462-1578 Commercial R •entiall
Phone:(772)462
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
5 WE
MR
Wilm-3
Address:
Legal Descrlptlon:�,P*���
r .. Da LotNo.
Block No.
Site Plan Name:
ProjectName;
Setbacks Front Back: Right Side: Left Side:
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ddixional work to be nertormed under thi;permit—cneckaff-U—mt T�:
Q-71
UJHVAC 11GasTank Dias Piping Ll Shutters Windows/Doors-
DElectric. ElPlumbing 75prinklers; 11 Generator 0 Robf Roof pitch
Total Sq.Ft of Construction; S Ft of First Floo
Cost of Construction: Cob& Go Utilities'-t Sewer U ptir. Building Height:
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Name.,,.Tbri\r\ HIM= 10MI
AddrAss: -
cityNoft S, �110 W(1�, State'. Offiff=lWay
Fax:
Zip Code,
Phone No.1111:0-UM5
E-Mail:
Fill in-fee simple Title Holder on next page(if diff erent
from the Owner listed above) 0
If va ue a construction Is$2500 or more,a RECORDED Notice of Commencement is riqulred,�
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JAN-15-2018 MON 11 : 28 AM CENTRAL SCHEDULING FAX No. 3212686;138 P- 003
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name; Name`
Address:__-- Address: I !
City: State: City: I i State:
Zip:. Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMP NY: Not Applicable
j Name: Name:
Address: Address:
City: - ---— City: ---
Zip: Phone: zip: Phone:
--- --- -77
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thb work a.nd 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;tliat 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,l do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucle 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 rion-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 redorded 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.
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Signatureq. o er/Lessee/Contractor as Agent for owner Signature f ntratorJLicense Holder
STATE F F ORIDA fJ STATE F LORIDA
COUNTYOF , UAM COUNTY
The fo oing ins ent was acknowledge before me The f oing instc ent was ecknowledgelJ�before me
this i day of. (.f a- 20 ,by this day of u i 20 by
Name ofRyrson making statement Name of p4son making statement
Personally Known lam.- OR Produced Identification Personally Known -OR produced Identification
Type of Identification Type of Identification
Prod ed Produced
(signature of Notary Public-5;�z E or' (Signature of Notary Public-StatVK lorlda)
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I-- 'f� tlherine Konger ;•., Catherine Konger
Commission N 112 s.AV0ri#FF1 2318 Commission N� s°g 'oB#FF172 7a
s. Icy, 13xpires:OCT 28,2018
BONDED THRU ��� 11ONDED THRU
ava• MYLORIDANOTARxLLc q�ar� ISTFLORIVANOTARM LLC
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
RECEIVED
DATE I
COMPLETED
Rev.8/2/17
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