HomeMy WebLinkAboutBuilding Permit Application FEB-21-2018 TUE 08; 58 AM CENTRAL SCHEDULING FAX No. 3212686138 P• 002/005
ALL APPL C BLE IN 1MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� t PermltNumber:
RECEIVED
Building Permit Application FEB 2 7 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, ermitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR, To Select from dropbox, click arrow at the end of line
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Address: 'if)"U"10, t. rc-P L I RZ,
Legal Description: �11 r W �
Property Tax lD#: ,� l� �r b l 1 Lot No
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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t ona wor to e e orme unclerthis permit—c ec a appy:
HVAC Gas Tank []Gas Piping 0 Shutters Q Windows/Doors
Electric Plumbing ❑Sprinklers FiGenerator Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ -1 5� d Utilities; Sewer 1�J Septic Building Height:
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Nam I Name:
Address. 0 C• Company- f J C 747C
ci,y: 1 YC e- Stater Address: W r -, ('
Zip Code: (F�x City: S Q- State:
Phone No. - IP - 14 Zip Code: bw Fax: �Ja D
E-Mail; Phone No. M
Fill in fee sample Title Holder on next page(if different E-Mail: Y 14 qM 041- 0
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from the Owner listed above) State or County L cense:
If value of construction Is$2.500 or more,a RECORDED Notice of Commencement is required.
FEB-27-2018 TUE 08 59 AM CENTRAL SCHEDULING FAX No. 3212686138 P• 003/005
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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
Name: 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 priorto the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize thepermit 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 1 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 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 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.
Signature of 0 n /Lessee/Contractor as Agent for Owner Signature of tractor/License Holder
STATE OF FL RIDA /I i STATE OF LORIDA �Q, Wo'e-1 COUNTY OF 1..� COUNTY OF lJJ
The f Ing Instru ent was acknowledg efore me The fo Ing instrum t was acknowledged before me
this dayof 20 y this ` day of 70 by
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Name ofaking statement Name of per on making statement
Personally Knownp OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
cz6jat, I k_,_� CA6at&4- - k�,
(Signature of Notary Publi - t� �F,lor' (Signature of Notary Public-Stat P ,�lorida)
tlhetine Konger , t' Catherine Xonger
Commission N �2 - on#1rP17Z371 Commission N C ion#FF17Z372
s.OGT Z8,201g "Expires Da 28,2018
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17