HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
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Date: 6 / [ 1 / Permit Number: ` VS 0�1 7
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COUNTY ..' RECEIVED
F. A. Oyt 1 77t R -
Building Permit Application MAY 09 2010
Planning and Development Services
Building and Code Regulation Division Permitting Department
St.Luci _ounf'
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.LOCATION
Address: 626 2 ganapi n c. Cir /95 L 314 qg Z
Legal Description: Lake__ Lot; c ES10 ?c s Pia). /1/6 l L OIL 2Z (Q_,^ Z LIC Z —
(7LIci )
Property Tax ID#: 2'124 - 70 3- 6036-660 -( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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Tcar oFF goof- Down 4o p (,►wood, r<pl'cc rolicc) ,I,�G�ovc� ops nL.cc)cc, re-nay/
-11ccd. 4-0 cods ins-ffill b{-IF ^C)I cre0 )racrlp1Mc,,
SitngIca -1-o ce,0c n gll a�c��fcc �vol
fL,S-c/ `/4I -eiicsh:no)cs) FL (60,1g_6C. L,,,dcr10,9mon+)
CONSTRUCTION INFORMATION -`_
Additional work to be pertormed under this permit-check all-ha apply:
III HVAC Gas Tank nGas Piping Shutters Windows Doors
l I p gQf Windows/
Doors
Electric 0 Plumbing Sprinklers 0 Generator /<. Roof (p� Roof pitch
Total Sq. Ft of Construction: z6 78- S Ft.of First Floor: z0 Z 3
Cost of Construction:$ q157(50 Utilities:Sewer El Septic Building Height: t
OWNER/LESSEE ns :. `ry. CONTRACTOR° '
Name O.,4a. .-ii)er,n94o,) Name: le1•ckarr.) Co II c-(41
Address: if Z62 Sonr3pilac C;r'• Company: 1 cat_ 13d67crS^ Poor alioa;r-
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City: Pdcf ,g. Luck. State: (=L Address: 6 I is I 6uchAn.,.n P '
Zip Code: 3y 93-Z Fax: City: 'f-Ori Pic rca State: tZ.
Phone No.( 77 Z ) 6 7 8 -/'1?5 / Zip Code: 3'/9 e Z Fax:
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E-Mail: 4ow G cr,nUia rl @11Oma
c. sI• , /-' Phone No. (77z) 3 3 2-8.c5-0
Fill in fee simple Title Holder on next page(if different E-Mail: r i cii is cr, 11e4-1-•; ®9Tha; 1 • C 001
from the Owner listed above) State or County License: SGC, i33 e q 76
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW"INFORMATION:
' A
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable ,,LL
Name: Name:
Address: Address: I
City: State: City: State: I
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 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.
sC/Pkori,.8. . (.'sg&ttrt) i . ,c( V , 63e-ealti--. s
Sign ture Owner/Lessee/Contractor as Agent for Owner Sig ture o�Contractor/License Holder
STATE OF FLO A, STATE OF FLORIDA77 � ''�
COUNTY OF `L rA 2 COUNTY OF of cuts 2
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this q day of YY\ 1 , 20 tc;by this_9_ �,t
day of r ,j ,20 18 by
71(2-, A V ,0D Ot -Ws 2, Ci ( , 011e
(Name of person acknowledging) (Name of person acknowledging)
a ? l.(Signatu) JiA
Notary Public-State of Florida) (Signature Notary Pu lic-State of Florida)
Personally Known V _OR Produced Identification Personally Known ( OR Produced Identification
Type of Identification Produced Type of Identification Produced
C C t1�•(o?S (Seal) Commission No.
Commission No. � �
` .....:.,,,,N.•' SALLY ORTES
SALLY PORTES '
s .au��un. = Commission#GG 47625
Atm r6 4 A,
s+'' Commission y ommission Explie• e
?�^ •M Commission Expires • •,r,,,' ` November 15, 2020
Revised 07/15/2014 i o�.` y : ��
'.,,��F�„ November 15, 2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS