HomeMy WebLinkAboutUntitled All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED o qGJ• Date: • Permit Number: I VYIS-
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B• uilding Permit Application s%';� r oepd {i
Planning and Development Services euoy egtl
Building and Code Regulation Division •
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2300 Virginia Avenue,Fort Pierce FL 34982 �/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: •
•
PROP®SEDllNPROVEM L®CATI ONo 4 ` '
• Address: 23os 5 r '']-16, S-
Legal Description: p/a tat e'..t.:54 i.i j `� dexr(
Property Tax ID#: 'Z'j Z v $02..-- c.w.3 j--Ooh ? _ Lot No. 1 .3
Site Plan Name: • Block No. y
Project Name:
Setbacks Front i/ Back: Right Side: Left Side:
DETAILED DE6C°IPTION� WORK°, 3 „ . w
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CONSTRUCTION INF®RMATIONg -1;i` ,
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: $ Aftr /V56 r 0 d Utilities: _Sewer _Septic Building Height:
OWN ER/LEASEE ` CONTRACTOR: -;-
Name
a:Name /jc. �rrk L;N c')5e1( Name: ,.-2745,,,e,
Address:. Z 'oS- S :2'7 7H 5 Company: %
City: F� /J, n<<, State: FL Address: Yf{_;y,tiGu-v /31c ./0 /f e,r)
Zip Code: 3 Vei g( ' 'Fax: City: P5( State: i=L
Phone No. 77z - 57/- !/ Cs- Zip Cod : -3/45,7, Fax:
• E-Mail: Phone No -772 ---5-4/Z./
Fill in fee simple Title Holder on next page(if different E-Mail •
from the Owner listed above) • State or County License G�3G:.s3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
•
SUPPLEMENTAL E0 NSW LICTI®N LIEN LAW I�N�F®RMATI®NtF .,,..' �, , '�r �� ',4` ', : u
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: 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner ature of Contractor/License Holder .
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF COUNTY OF S 1 -I,.A___.,2 A—e
The forgoing instrument was acknowledged before me The forgoing instrumpt was acknowledged before me
this 31 day of , 20\ by this ( day of -40- 1 , 20 k-by
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1 JJ/`C_. 5�f i .5- l.c- /S" :,/r
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(..yof person acknowledging) (Name of person acknowledging)
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( ignature of Notary Pub c-State of Florida) ( :na ure of Notary Public- ate of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced IdentificationL/
Type of IdentificatiType of Identification.
Produced //-) Produced
Commission No. (Seal).. .-,--,,,...-1,-,z7_-_-4 Commission No. .�,o.'a. al,; `(Seal) I N AMS
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Want PtIoitS .r.,Df F, -•_(., t
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REVIEWS FRO G ° ONI1 .,I_ .''` .,
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COU ,t oFF,°; EMb(Wthrouahr!�atREVIEW. n, REVIEW REVIEW REVIEW REVIEW
DATE -- ., ,�— ,
•
RECEIVED
DATE
COMPLETED
Rev. 7/2014