HomeMy WebLinkAboutSnelson 1All 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
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: fe��60
JNPROVEMEN TION:
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Address:
Legal Description:
Pro pertyTax ID#: 3R11,0 `SDS -03S0 `BODD Lot No.1__
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
RFAILED DESCRIPTION OF WORK:
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Sln in�,�e. S
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Additional work to be performed under this permit - check all that appy:
Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_Mechanical _
Electric _ Plumbing _ Sprinklers _ Generator Roof S N etch
Total Sq. Ft of Construction: Z's; -OD Sq. Ft. of First Floor:
Cost CQn;traction_ $ 000 OD Utilities: _Sewer _Septic Building Height: IQ 1
Name 6_ Ve SUMP_`
1v-,
Address: Company: lr 4
City: F;bfF- Ptejze_� State: Addrs:
Zip Code:3td&L9jZ, Fax: City: Stater
Phone No. �0 "'Tibti �- g7 Zip Code: �6'r Fax: 77l �o
E -Mail: Phone No 77�3 iS
Fill in fee simple Title Holder on next page ( if different E -Mail tCS \ty1\L\
from the Owner listed above) State or County Lice ewe- V A
If value of construction is 2500 or more, a RECORDED Notice of Commencement is re fired.
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY:Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conWict with any applicable Home Owners Association bylaws
rules, orand Eovenants 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 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
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
comm nein work or recordin our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
WaA�'�
Signature of Contractor/License Holder
STATE OF FLORIDA_
STATE OF ORID/� j
COUNTY OF ��—�1tt J
COUNTY OF Jl� tUL� J
The forgoing inst ment was acknowledged before me
this—jael day of 20it by
The f Ang instr ntµ 7Fg was acknowledge before me
this day of 2 by
W 0,41AIA.L,L0,M%/`-
Name of
/.t —1�
Name
pfffion making statement.
of person�g statement.
Personally Known �a OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
r..
nature o Otary Pu li, of Florida 1��I IRTri
naiur f Notary Pub!' of F an a JAIME ORTIZ
r - Notary ►yp .. State of Florid
y Vublic • Slab of Fmnda
- AlyCgldg
Commission No. -'}h. Eyv.r Jun 1 201
ommission No. Jun 1. 2018
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`y'? .Commlpion FF 111485
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE. MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.