HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: / l 1 j Permit Number:"!!
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division '
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ! Res'idential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: -+?!71 ior-q e,lrl S Un I&Ig rj-.
Legal Description: ! hlke a i` f 511 QTA,405 Tbf-r: a N 41, 814O '°E34K,93-F4 LD- -94 a_nd
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W3 10 Pt Lef 8* 1-C,5s 1l aa3 .74 A- a ,id- 1 ed!; 5 .1D,2,9-7 Pf i
Property Tax ID#: ,340,g- 6'0.1 - 014-7-046 Lot No.
Site Plan Name: MrKC, Ltlidr-wil Block No.
Project Name: I' i be 1&),d heY-
Setbacks Front Back: (P r Right Side: (.o �r Left Side:
C � II: D dES RFI IflI�lI= R2z
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�"'fq f4- 5-F4 hip `I- r-M I horse cinch wi+h 4�1�+ 1 tiro ;a,1VaAtzed__
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itiona wor to e e orme un er t is permit-c ec a appy: ,
HVAC �Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
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Electric ❑—Pum ng Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: A/hi S Ft.of First Floor.:
Cost of Construction:$ YJ 4-0 Utilities: Sewer E Septic Building Height:
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Name e-1 'e- i Gj e-r- Name: n1 onoL
Address: J+7-71 Jornq p n 6cm. O-d' Company:544x!+ Fe,prie-P-1 (Zuni pQc.y)V
City: F+ pl e,me, State:j_(r Address: P 0 6OV- 64.,3
Zip Code: 3 4-9$I Fax: City: 54-tta_'^i� State: F
Phone No. `I 7�), 475- 51-1-7 Zip Code: Z4- l( ,5 Fax: 77a--aT9-303f
E-Mail: Phone No. -17 a8W,�-j 151
Fill in fee simple Title Holder on next page(if different E-MaiObk)eil(5D a4-A. ►tee+
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.'
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DESIGNER/ENGINEER: �/ Not Applicable ,I, ✓Not Applicable
pp MORTGAGE COMPANY:I
Name: Name:
Address: Address: !
City: State: City: State:
I Zip: Phone Zip: Phone:'I;
FEE SIMPLE TITLE HOLDER: y'Not Applicable BONDING COMPANY: I Not Applicable
Name: Name:
Address: Address: 1
City: City: I i
Zip: Phone: Zip: Phone: I i'p
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do th,e workland installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit. I'
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 covenan&fhat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictionslwhich may apply.
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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',roomladditions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory l ses 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 ' st inspection. If you intend to obtain financing, consult with len r'or an attorney before
comme In or r recordipg your Notice of Commencement.
Sig of Owner/Lessee/Con ractor as Agent for Owner Signature of Contractor/Lice' I e Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Ma,A-6✓1 COUNTY OF
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The forgoing instrument was acknowledged before me The for Ing instrument was;ackno I ledged efore me
this d0. r_
ay of m - , 1 20� _P=
by this lay of (01 A_4rC3 1 ,20 by
C�►es�.y' c�1 PYt o-:�. ��54R>V -c
Name of person making statement Name of person making statement
Personally,Known ✓ OR Produced Identification Personally Known OR Produced Identification
Poelof Iddentification Produced i+
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Type YP Identification'
DIANE K BOND
L01 1� l _? '€ MY COMMISSION#FF185430 ,,.� /
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EXPIRES December 28,2018 LA_g41 ld.!!'';
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(Signature of Notary F LaindIPTOtarysurvico,com (Signature of Notar'
DIANE K BOND
Commission No. (Seal) Commission No. I
_•' - " —MYIC0mMI&89#FF185430
;wF:
.`oF� ° EXijIRES December 28,2018
407,,•399.3152 lFIGrldtANZ=111 rv169"1r1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION i SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
It DATE
RECEIVED i
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COMPLETED
Rev.8/2/17 h
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