HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� • O�6
Date: G • y ' � Permit Number:
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_ R EE C E I V E
Building Permit Applicati n :71
Planning and Development Services ,
Building and Code Regulation Division P2 rm It
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi erRaI L
PERMIT APPLICATION FOR: c //1400 its
PR'IM-5ED INpROilEMEN LOCA ICi}N:
Address: 917�( -1fL&;2 _ Gl,V--j
Legal Description: Jf ANAyA� Gia ,�zEl T_tA e
Property Tax lD#: 3C4a5' _?D Z D l 5?6 61086 Lot No._29
Site Plan Name: Z PC-W66, Block No. (g
Project Name:
Setbacks Front Back: Right Side, Left Side:
DETAILED DE.�SCR+I;PTIQN OF WORK;
fly ll 5 1 6 U I✓— AV-J
C TRU TION
I NFOR M AT ON:
O S
itiona wor .to be,.pertormed un er t is permit-check all that appy:,._
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric —Plumbing _Sprinklers _Generator Roof Z(IZ Pitch
Total Sq. Ft of Construction: ( '1oD Sq. Ft. of First Floor:
Cost of Construction: $ 7 7 g Utilities: —Sewer —Septic Building Height:(5
ouN /LScoA, Ta oR;
Name A,0'12 e6ni iz Ci_ . Name:
Address: c�Z). ��O�L�4 Graffi Company: r�,v� =rr�G� «G
city: S f_ State:FL Address:3,L71 OL�Gj&jDOL;4,va=
Zip Code: 3�(�t,�?� Fax: City: F-1-Pccpm, Stater
Phone No. •7 7, Z'14( P 35"Z Zip Code: 3t-(,$Yy Fax: -z-7 7— 4tE1•-&t1K'
E-Mail: Phone No `1TZ 9LW-7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C(,Gb,S 73 �LD2
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
JUSAPM4 ENTAL CONSI'R4U'C ION LIEN LAW IiNFORMA ION: Ailffim
WMANUff—
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 yo roperty. A Notice of Commencement must be recorded and posted on the
before the first i ec ion. you intend to obt ' ng, consult with le or n attorney be f re
commencin rk or ordi tice of omme ement. W
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Signatur of Owner essee Contractor as Agent for 0 1,419a igna re o is se Ho 0 0¢
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STATE OF FLORIDA - "'MW Mw
�� TATE OF FLORID o
COUNTY OF � OUNTY OF rim
ow
The forging instr nt was acknowledged fore me he f ring ins n was ack owledged befor
this�� day of 20y , his day o 20J r"by
V e.T ...... �*�v in IQ G-V )q
Name of person making statement. Name of person making sta ement.
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
&,Jut,+
aX444'•
(Signature of Vary Public- tate of Florid ) U (Signature of N61ary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.