HomeMy WebLinkAboutBuilding Permit Application A BLE INFO MUST BE COMPLETED FOR APPLICATION TO ACC�PTED -
Dat — ( _ O"�' Permit Number:
At��00
RECEP D '
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�- Building Permit Applica ion
Planning and Development Services MAY 6 1 2018
Building and Code Regulation Division Perm ittln9 ePe rtment
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re id§kiz4UCiWCn,LntY, FL
PERMIT APPLICATION FOR:
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PROPOSED INPR�VEMENT,L'O;CATIO�N. m
Address: OSS /-t I A f4-CIj1r_)s0'J - ft 14
Legal Description: CID 1�of c C-6(/c- p��� 517C 110 Ai ccbn�
Property Tax ID#: 2 S2`7W-616-7 W "v —66016 Lot No. J
Site Plan Name: CT Ulm df Block No.
Project Name: 07-64.m^
Setbacks Front Back: Right Side: Left Side:
WTATEED' DE1S �RIPTION7.
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C1 ry FLooK u t r Aw..•J f��Si 141 S Dh
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CO'N TR,UCTIO'N-INFORMATION ra r'
sM -l� arr � �imn5;t"#Yuwl:,e",#. a �,; .ard."�
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction '5,,,,"/.-:•:x:00„- Utilities: —Sewer —Septic Building Height:
011N�,ER/LESSEE: '2,,y ,�1y� � ; CO�NTRA'CTFO.L�R
JN �: ...i'. ■ iL[ :YJL Y—Y.'X.. _.,f. .:FN4"lam-A�` ..R'i.!-
Name G t{. . ..,,: &�.'n'1 `,.,`. Name:
_ S d/
,r Company:
Address: r4UF �.” L., CsEN
City: State: „ Address: o�
Zip Code: Fax: City: bout Stater
Phone No. r — Zip Code: 3 3 3 Fax:
E-Mail: Phone No C): 11/ 6yCf_ Zg�T 1
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License 1� 6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP!FtEMENTALC P,Ni SM 1C1-ION L1'EN LAV1/ INF®RMATI®'N:
DESIGNER/ENGINEER: Not Applicable
— pp MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
"City,: State: - City: State:
Zi v` "Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: t Name:
-Ad,dress: Address:
City: City:
Zip: _ Phone: Zip: s 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 thepermit 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
_str-uctur_e.-P-lease_cons-u Lt with y_our_H-ome Owners Association and review your deed for any restrictions which may apply.-
In
pply.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 prope . A Notice of Commencement must be recorded and posted on the jobsite
before the first i specti n. I ou intend to obtain financing, consult with lender or an attorney before
commencin k or co i our Notice of Commencement.
Signature o Own /Lessee/Contractor as Agent for OwnerSig ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2 day of Y>co vZX- 20 tai by this:Zq day of ¢ f&t L ,20/5,<by
CSU 0A 4--
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of N tary Public-State of TToh6a )
Personally Kno O Pr d ication Personally ouYPG�•, t WN&rte? Ficat n
Type of Iden —S' �' �i �o otary Public-Stato of Florida
yp t �j4V Type of Ide t
NOTARY PUSUC STATE OF FLORIDA •? Commission N GG 057931
Produced—*- * Produced
F 207274 n 8.2021
P EXPIRES:MARCH 8;2019 '�'' ��
` � o �'%�°�n��`�� Bonded through National arft sn.
CommissiowftPFfl0 9onded Thru National N(-swm"n. Commissio 110
REVIEWS FRONT ZONING SUPERVISOR PLANS .VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW - REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE" -
COMPLETED'`
Rev. 7/201. 4