HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED D `I A00
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Date: "f' '� � �� � Permit Number:
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Building Permit Application APR 3 201
Planning and Development Services Permitting Departme
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. LU CI County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: y ys ✓C12 01W LAo,)i'
Legal Description: �IVI;'1� oA-)4 rST1iTI:--S Lo 1 Z.S AJ0 rL 0'f
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PropertyTax ID#: 2 L-1 3 0 - -6-01- 002-5- - 0001`1 Lot No.
Site Plan Name: A 7-TAC-11 6 0 D 4 A Block No.
Project Name: f- -A00f 1,JG f 012 k069R7 7-0D0 C/q S#
Setbacks Front Back: 2-1 Right Side: 3 1 Left Side: y
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PEMOVE + fix1ST ,J6 Sly d 6 t 200 Cl'
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Additional work to be pertormed under this permit-check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing =Sprinklers _Generator ✓ Roof Pitch
Total Sq. Ft of Construction: 3 Z (Do Sq. Ft. of First Floor: 32- 00
Cost of Construction: $ 11 _5-0 0 Utilities: —Sewer /Septic Building Height: j.�0
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Name A061_'-/Z7' TOAD CA.S%J Name:
Address: L18 V- /Z Iy 6P, 0 0 K L/9a 1= Company:
City: P T_ 'D 1 f;2 C% State: Address:
Zip Code: 3 9 9 8 1 Fax: NIA City: State:
Phone No.))Z- 96S 1'135'1,1 )72-ZG 7- 1?11 C_ Zip Code: Fax:
E-Mail:TODD cA51Y S S C GMAjc e C(?%-1 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL PtoftIlt'NZ"
R
DESIGNER/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: 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:view: 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 recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Age Signature of Contractor/License Holder
u_
STATE OF FL,OR STATE OF FLORIDA
-
COUNTY OF ed COUNTY OF
The forgoing instryfj�ent was acknowledge The forgoing instrument was acknowledged before me
thi�day ofil"YA—)JV_, 20by this day of 20 by
N.
CAVL- S&Yti......
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notau (5ignatur6,of_Notary Public-State of Florida
V
Personally Know OR
R Produced Identification Personally Known- OR Produced Identification
Type of Identification/y • Type of Identification
Produced Produced
Commission No. _U (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
I COMPLETED
Rev.