HomeMy WebLinkAboutBuilding Permit Application SUPPLEMENTAL CMM. CTIQN,LIE'IV. 4 I:NFORMATI' No ,.- *;. ,, ..'..
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DESIGNER/ENGINEER: ' ' Not Applicable MORTGAGE COMPANY: _,Not Applicable
_ .-Name: _ Name:
Address: V 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 prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permitsu
holder to build thesubject 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 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 re ording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agen_, !,,.i ,s_-. Signature of Contractor/License Holder ,
r STATE OF FLORIDA ;,?...
STATE OF FLORIDA r !
COUNTY OF f L.L.L& i� '".-=1. COUNTY OF S'}'.LAA,11. * s • .
0
The for oin instrum nt w s acknowledged bef. The forgoing instrument w s acknowled es
g � r g � g g � g �����
this I b day of r t 4 ,20 I b 2°o o , this day of �r. ,20 `i 2 9
° �r�' 2 mrt SI
rt Q o CA Fo
war Lame- 5C � t.Jah S.
(Name of person acknowledging) r-n (Name of person acknowledging) ' a-,—A i 8N
ti / ab 164P" Aari a ntilliPle;
(Signatur f f Notary Pu.lic-State o Florid (Signature of ftary PtibFic;:State of lorida) I
Personally Known OR Produced Identification V. Personally Known OR Produced Identification V
Type of Identification Type of Identification
Produced FLA 4... Produced ,�Ll 0
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT , ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ,
RECEIVED
DATE ,
COMPLETED .
ley.7/2014
All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED (/
Date: �'' Vg I Permit Number: '�6 @ - I -3Sj
ili.
c.M it r . =- ; qp 440
C o Mir 0 .R. Pero R 1F ?419
Building Permit Application Stiff„9Deparh
Planning and Development Services county ent
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 6
PERMIT APPLICATION FOR: .
PROPOSED-ft PROVEMENT LOCATION `' 3 r- ' 074' .t ° w i'<
Address: 2 6 o2 C.1j- -L (C-e f” 6+T
Legal Description: SA-c--('tr-i o TLri-Z✓i
Property Tax ID#: 11/27- 8 0L. -0626 "dc-oQ 6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAEDDSCRPTONOFW , i i4vr -, `- ` `- � , ` . t'
L "< sw- _ 's Y - ��? '- � " ,0- x7 : .'.. x_ rrigr! e ,.1,.. '
or') "-s Jibe_e_T-RD,-J PD .)Lr/' -S ei J e) l=F Fa:/'
Pki-ok -i-.S2-
` fi Y �, ... moi a[ 4,' 440,Z`a,'; 3 . s ,.r s ! ,„.,„T ' g1 # �F 4 + rz
a a� �a Y& � ',4..C1.1.4" , R n ±a � a .� a r P Y A 8
C.. N;S`TRL CTION INF�,®,R3MATLQ'N� ' k fir 4.:, .� .. ,1A -x, -` , ?`�'T. ez` 5.:, ':.�
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
—Electric —Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3 0'° ';'* Utilities: _Sewer _Septic Building Height:
OWNER/LE�S5'EE V , �. r 4 a g � 4 ', a , `' C®NT'F'TOR . E 13 r#. t ; ;1` a4'
.. 5a:.(• . „..ass•-...A 0 . x..�.e,.:+.. 4..f. s ,.... ati ti - ... 1 - - I" :S..,..e,.,,,, . 1. ...,— < ., ,
Name G e rare.. vet-de e E i r1/L✓y Name: :Jt.-AVS d .- . rn
Address: 2O 3 t.2,t, la+.J 7 T 1 -A-J't- Company: g.• 1. v-. k--r•E-f 2._.c. L,7-r-c.
City: -e /Pci'fl v State: 7-c_ Address: 'io o Com` e--e-e-E IP r-
Zip Code: Fax: City: OIL- .Oi State:'FL.
Phone No. Zip Code: '.32?'2 6 Fax:
E-Mail: Phone No gb1 4-16-/. _ €, I 1
Fill in fee simple Title Holder on next page( if different E-Mail F!.. 3,,,. Cr I-f „PC,. 7i€+..c n.,
from the Owner listed above) State or County License ‘2. ,'3 o 21--( 6-) )
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.