HomeMy WebLinkAboutBuilding Permit Application From:Bailey Whittemore Fax:(800)757-0066 To: Fax: (772)462.1578 Page 3 of 4 06!2812018 10:40 Ala;
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) B,
' 0Date: �• ' Permit Numberj/ a`Yc we-?_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772'462-1553 Fax-(772)462-1.578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox,dick arrow at the end of line
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Address:1 cIr -
Legal Description: �'C��'' f� :; .,. _�...r {� l\ 1 t 1-C' \
Property Tax lDfx: 3-tt 7�E `�`,..�,.�;:' !�' (:, Lot No.
Site Plan Name: ' Block No. _
Project Name: (?t \ --
Setbacks Front Back: Right Side: Left Side:
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C4�iSTRJG1tO 1NF£}R}R(�ffA�lt�E�t. z _
Mdmonal w-K-o e e orme un er t nis
i s pertntt-check�all ap
4VAC FI Gas Tank ®Gas Piping Shutters a Windows/Doors
11Electric InPlumbing 05prinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S .Ft-of First Floor:_
Cost of Construction:$ C. f" Y`�•r y_ _ Utilities: Sewer Septic Building Height:
O�"itillERfLESSE� � � __ � A , 7 'Ct3i�f1'RACT{7R��
Name (lCu) ttS( 5`�L Cxi),tk i ^ Name: lt('�
Address: �.)r' t � .y(`i( S-t�. ri �JlC` Company:
city: kCSt }c t gulf Stater Address: '55"- v),-�) ub f_.:.: -k
Zip Code: ': Fax: City: `h S1k'_ State:
Phone No. a�5•y5.`0u1_ ml-� _ — Zip Code: 2JLC�_69 Fax:4114 r)-t•.-g"PSA.
E-Mail; - Phone No. tvla •
Fill in fee simple Title Holder on next page(if different E-Mail: [�lC'-.�K-U�r f 45� � �I i✓� � �
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
"CEIV"Or'
JUL 2 2018
Permitting Department
St. Lucie County, FL
From:Bailey Whittemore Fax:(800)757-0066 To: Fax: (772)462-1578 Page 4 of 4 0k912018 10:40 MA
Sl1�PLEkd9ENT CD.iVTRUTI ?i LIEN tA1h/.:INE®RPvt7)Qhl,: . ::.::..
DESIGNER/ENGINEER. Not Applicable ; MORTGAGE COMPANY: Not Applicable
Name: Name: I
i Address: _ Address:
City: State: 1 City: State:
Zip: Phone 1 Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: Not ApplicableBONDING COMPANY- Not Applicable
Name: _ I� Name:
Address: ;Address:
j City:— i City:
Zip: Phone: LZip------ Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a pennitto do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
5[.Lucie'County makes no representation that is granting a permit will authorize the rmit 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,l do hereby agree that 1 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 afull 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 bilure to Record a!Notice of Commencement may result in your-paying'tvaiae for
improvements toyour 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_recordingyour Notice of Commencement.
Signature:of Ow6er/Lessee/Contractor as Agent for Owner Signature of Contractor/Lceh'se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTYOF 1�
The f r Ding instrument was admowledged before me The f r Ding in meht was_acknowledged before me
this day of 20_%by this day of 20_ri�by
Name of per making statement Name of p�r�pn making statement
Personally Known OR Produced identification Personally Known x 1 OR Produced identification
Type of identifical Type of Identifica n
Produced Produced
(Signatur f Notary Public-State of Ft rids) (Signatur f Notary Public-State of Florida)
t ;t �;°4c HIIU.YNICOLEK"S i �y'!"°`t kiOLLYNCOLE
I Commission No. 9yt0MM8804$.FF1d21 Commission No�a(� a e�IjdYG Afi5510tVPFFi
EXPIRES:August 5,241 EXPIRES.Augusl5, 6
�i +FSR " EW�Eedn,NB �e:N !Sa1v' �f?avV 97dJ!d7ka8tdgtiNEfary
REVIEWS FRONT ZONING I SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW ) REVIEW
DALE -........_------ --
RECEIVED
DATE —---
COMPLETED
Rev.812/17
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