HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rl
Date: c Permit Number: f n 04 1 1 •
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F L C? R A 0 i i. ^-
1 Building Permit ApplicatiOnnitg u►tr,enf
Planning and Development Services `
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 t//
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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PROPOSED ONPROVE LOCATI+ ' o ' ,;' : :'''' .
Address: g q S N okra iv A (/l e/
Legal Description: CRI TI- `�`\ L Li 'J A i` e 2_ L 'D
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P
39, 1 N
Property Tax ID#: 3 1-1° iq ' 6- DI:::) 22._.• U C*-)C. ' Lot No.
Site Plan Name: Block No.
Project Name: •
Setbacks Front Back: 0S 1 Right Side: Left Side:
QUAILED CRIPTION WORK ... 14,� 4-
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DES a
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CON5TRUCTIO EFORMATIONo
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: $ /--_-,x-- 676, 0 C.) Utilities: _Sewer _Septic Building Height:
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'OWNER/LE4SEE° i'"::°
.q•: `;:' CONTRACTOR;, ; 9 , a ....
Name ZJ o,Se Li /e.._./ Name:
Address: ,3r 5 //, ,Q /7 AZ/6--r—
Company:
City: ?S - State: Fl Address:. •
Zip Code: 3 VY8 Fax: City: •
. State:
Phone No. T-9`3 V ` c:•)6, (7/ 1. Zip:Code: Fax:
E-Mail: v v E T' (a', Ov4, (dG , 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.
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SUPPLEMENTTCONSTRUCTION IIM11INFORMATION. i
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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i a •re o caner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ATE OF FLORIDA . STATE OF FLORIDA
COUNTY OF � ) • C (Q COUNTY OF
The fpr,going instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this I J day of .k.A1l2__ ,20 tg by this day of ,20 by
,0Se.fp1 UDOL\fir- liQ,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification \// Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced P 1-I fD Produced
1 Y-06/ k:1.i,
(Signature of Notary Pub• tate of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) c�+; Nor,, Commission No. (Seal)
%,9,1;"!,, f,•
REVIEWS FRONT ZONING SLIPy/j5 R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE Q o -' —'
RECEIVED m 2 5.°m
< w = am
DATE ow.*" W
COMPLETED =No �o c
rev. 8/2/17 N X m -nra72.wv0
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PLANNING &DEVELOPMENT SERVICES DEPARTMENT
SL 1e C- Regulations Building&Code Re ulations Division
F L o_R I oA 2300 VIRGINIA AVENUE
• FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT •
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I,the undersigned, am the owner of the following described property,
f 1 52 6062-Z )°Q3
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St.Lucie County Land Development Code,I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not• adversely affect the immediate
community. .
5pti 1r9_
Property Owner Name(Pleas- Pr' t) •
I9/ 5une / 2
Pr.. I er Signa e Date
STATE OF FLORIDA,COUNTY OF S 'W.
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ACKNOWLEDGED BEFORE ME THIS l DAY OF Jam()(ye_ 20 l 0
BY i0&&7-h 4O IIS PERSONALLY K/NOWNN TO ME OR WHO HAS
PRODUCED �--+d' ' 1 `t— 1 ► //`� AS IDENTIFICATION.
J 1 �./ /-/ 4J
SIGNATURE OF NOTARY PL �i TYPE OR PRINT NOTARY
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COMMISSION NUMBER •
•
(SEAL)
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SLCPDSDRevised 04/I1/2011
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1,arP+, HEATHER BURF0RD~
o.�I\ s State of Florida-Notary Public
71 Commission 0 GO 183217
%,74„0, My Commission expires
February 06, 2022