HomeMy WebLinkAboutBuilding Permit Application (2) i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 ✓
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at�the encs of line
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�pROPOSEDIMPOUEMENTxL( CATION � � r + _�
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Address: r ds' le 3 o79So�
Legal Description: 1-/Y1 k.S d Vanfla CJU b a]/,c Z&�J c2j&D
Property Tax ID#: Ji/o176 7- 9-231- ADD -a ! Lot No. 02/
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Site Plan Name: Block No.
Project Name:_&2r7die.✓�i
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Setbacks Front Back: Right Side: Left Side:
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itiona wor to e e orme un ert is permit-c ec a appy: ��� In..i
HVAC �Gas Tank ❑Gas Piping �Shutters i Windows/Doors
Electric ❑Plumbing Sprinklers Generator t Roof Roof pitch
;Total Sq. Ft of Construction: GYM 7 Sq. Fitof First Floor: I i
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
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�01NV�R/LL�SSEE.� p � z �k xtGO�ITRCTOR, �
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Name /4 Name: K60tl lgoa
Address: 91.a3 q hl&le ZCompany: C,
City: P121-1 Sy- 4"C I° State:B Address:�??c� 14�f�Q r00 S�
Zip Code: J all 12 — Fax: City:
do do State:
i Phone No. 7W- 01- 707V Zip Code: 3019070 i Fax: 103 SO-03R7
E-Mail: Phone No. 3a/.-ysy- 4.5 3 1
I Fill in fee simple Title Holder on next page(if different E-Mail: Q, 1
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!from the Owner listed above) State or County License: ie /c3
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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tiS.l1PPLE�VI�NTA CD]\ISTtUCT1.0L1:�N YLAW � IOMAT10
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: I
City: State: City: I I State:
Zip: Phone Zip: Ph,one-_'
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: '
Address: Address:
City: City: I I
Zip: Phone: Zip: I Phone: 'r I,
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit. j
St. Lucie County makes no representation that is granting a permit will authorize,the permit holderjto build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that maty restrict or prohibit such
(structure.Please consult with your Home Owners Association and review your deed for a i y 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
n accordance with the approved plans,the Florida'Building Codes and St.Lucie County A i endure its. I
(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 -
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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 of an attorney before
commencing work or recording our Notice of Commencement. I�
Signature of Owner/Lessee/Contractor as Agentfor Owner SignAdreidt Contractor/License Holder
STATE OF"FLORIDA STATE OF FLORI. �,jQ
COUNTY OF COUNTY OF V , p
The forgoing instrument was acknowledged before me The forgo ng instrume t was'a'knowledged before me
this day of ,20_ by this day of 120a by
Name of person making statement Name of per ;
m king statement
Personally Known . OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced P ced
t
(Signature of Notary Public-State of Florida) ( gn ure of Notaryil ublic- ate of!Florida)
Commission No. (Seal) mission No. yV =ro""Y` ��NINE SCiAPI 10
°I $MY COMMISSION#C G1 I 0900
I
%aod�'~" EXPIRES October 2 1, OZO
I '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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2018/MAR/23/FRI 08;49 FAX No, P, 002
sc. fa•11t...+,•L111.� A"l <'
� 4°iW?:h' :� ?fib' }y(GNER 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:Applicatlon is hereby madeto obtain a permit to do the work and installation as indicated-
1 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 1buiid the sul4ect structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that ynay restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restriction
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 anothpIr 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 ark attorney before
cornmencing work or recording our Notice of Commencement.
Signatu�oOwner/ essee/C actor as Agent for Owner Signa re Contractor/License Holder
STATE OF FLORJPA STATE OF FLORIDA
COUNTY OF J'/°a& COUNTY OF (/a
The f r oing instrument was acknowledged before me The ff o' g instrume i was a kngwledged before me
this 'day of _ � �L 20 by this day of 204 by
Name of person aking statement Name of person aking statement
wn
Personally Known OR Produced Identification Personally Knot�OR-1--d ldenuflcation
Type of identification Type of Identlflcation
ed P ced
(S• n ure of Notary Public ate of Florida ( gn ure of Notary Public- to of Florida)
Commission No. �� JANiIlMR5 P.9CGFllO mission No. ►JV "�y'Y'` e Fg`NINE SOAP! 10
`s MY COMMI��ION#00040900 '�'
°' °� MY COMMISSION#(3 31,to9oo
EXPIRES Oatobor 20;2020 PXPIRES October 2 , 20
qF
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA.TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
PATE
COMPLETED
Rev,8/2/17