HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA /LE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /g Permit Number: l t — 0 -
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itimimmaimeow Building Permit Application qaR ro?o'®
Planning and Development Services ern/f.,,St 9
Building and Code Regulation Division •Cucie–pa
2300 Virginia Avenue,Fort Pierce FL 34982 COUn4,ent
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ,71+0 , o._T4- A bet T Rg4G�
Legal Description: 55E. 41721 C-1460
Property Tax ID It: /403– l20-- (900 3 -O/O -3 Lot No.
Site Plan Name: /v/4 Block No.
Project Name: OW 12S
Setbacks Front NA- Back: WA- Right Side: 4(,.%- Left Side: QUA
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: .
Additional work to be erformed under this permit–check all apply:
HVAC IIGas Tank ❑Gas Piping Shutters Q Windows/Doors
SElectric 0 Plumbing Sprinklers El Generator j Roof Roof pitch
Total Sq. Ft of Construction: /'a" S . Ft.of First Floor: 4/./'a"
Cost of Construction:$ 2. to,O •Cho Utilities:Sewer ElSeptic Building Height:
-OWNER/LESSEE: �1. CONTRACTOR:
Name k1&t4 - k -' M C.eoce1 - Name: 74(40 Ahcrod J
Address: 614t7 No17414 AIA Company: 7:4121-)4C7:4121-)4C--.7"J ( £7?�1lG �lo�ilNl
City: f t i' 1 /2.GE. State: FL. Address: 6.22. g/640.14.1ib SGV, SVITE" /Of
Zip Code: 3 l/11 Fax: City: Nl1ly State: PL
Phone No. 112. -52-1 -T557 Zip Code: %S Fax:
E-Mail: KeeoPer@,hadmisieyZ,trP.a✓f2 Phone No. 77Z'128 (o io2 772. '4855 8/0o7
Fill in fee simple Title Holder on next(page(if different E-Mail: difiVCZIr fl zieniiVGG_e..osn
from the Owner listed above) State or County License: C!'C�G /51/8 2S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S{UPPLEMENTAL„CONSTRUCTION LIEN LAW INFORMATION a i
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: C12E44o2i Jath@ gehAitattr Name:
Addres$: 333 1-144” VT" sUVTC. T Address:
City: V VX=hC4- State: Ft— City: State:
Zip: 32'9VOO Phone 112. 2.1'4 0411 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: X Not Applicable
Name: SAM,r 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 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 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 Commencementmust be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult . or an attorney before
commencing work or recording our Notice of Commence.-- .
Signature of Owner/Lessee/Contractor as Agent for Owner ':nature of Contractor/License o e
STATE.OF FLORIDA STATE OF FLORIDA
COUNTY OF +nct IZ:v-c.' COUNTY OF 1r\)i ,k, �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Ib day of ce..io rvs4n.1 ,20j by this j day of . -b 1 w ,20 1 a by
4E4, Coo pg.( L.CL,rvl Ova��GC,V l Y
Name of person making statement Name of perso mnaking statement
Personally Known IC OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Publicalg FJr y (Signature of Notary„�• •:tiypf p jBuC
1-2L _STATE OF FLORIDA
Commission N• f" NOTARYPUBI DIA
� Commission No. or o omm#G(�,��� 13
OFas �� SINCE 191 Expires 5/2/2021
Comm#FF182166
%E t9 Exp-re8 120201
REVIEWS FRONT' ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED '
DATE '
COMPLETED
Rev.8/2/17 .