HomeMy WebLinkAboutBuilding Permit Application From:Bailey Whittemore Fax:(800)757-0066 To: Fax: (772)462-1578 Page 3 of 5 08;0112018 10:05 AN1
ALL APP BL\IP\1T MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C(h1
Date: 1 , v Permit Number: v V
' LLc'e
CEIVED
Building Permit Application
Planning and Development Services 0 120
2013
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 Commercial Rntyr Permitting
PERMIT APPLICATION FOR: To Select from dropbox,click arrow at the end of line`' V
Address: C? lJt ,
Legal Description: l°1�r/��--3�� �)(v
CIA
Property Tax ID#,:,'I- 64( -0'2)Ui7 (BOO-V Lot No. D1
Site Plan Name: . Block No..l(Aiz-
Project Name: �t
Setbacks Front ack: Right Side: Left Side:
witMa
to ,
Additional vior o e er orme un er this permit-check all appy:
Gas Tank [:]Gas Piping LJ Sfiutters ❑,Windows/Doors'
eVAC
lectric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ :7$� t-( Utilities: Scwer®Septic Building Height:
1 ( IFRL�St , CQ }TRIQCt — t t,s .
Name��OName: _ C
Address: j} _ Company:* �c (w( ___
City: ` dee' e_ Stater Address:
Zip Code:A1C,
Fax: City: 2t
State:
Phone No."M l-- c` sE- C5 { Zip Coder Fax
E-Mail: Phone No.
I Fill In fee simple Title Holder on ext page(if different E-Mail: i
from the Owner listed alcove) State or County License:
if value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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From:Bailey Whittemore Fax:(800)757-0066 To: Fax: (772)462-1578 Page 4 of 5 08i01i2018 10:05 Atv':
SllPPLEf1/IEf�TAE.COh��TRk1_GTl()�6 LiEI�:LAW l�t�QR1VlATlON; .:; ._._ �'
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: �NotApplicable i
i Name: Name:
!Address: Address:
1 City: _ State: City: State:
Zip: Phone Zip: Phone: 1
----....... ....._...:...._._
FEE SIMPLE TITLEHOLDER: IS,Not Applicable BONDING COMPANY: „Not Applicable
Name: Name:
Address: Address: _
City: City: 1
Zip: Phone: Zip: Phone:
OWNER/CONTRACT40A AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.'
(certify that no'work or installation has commenced prior to the issuance of a permit.
St.Lucle County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in ontJict with any applicable Home Owners Association rules,bylaws or and covenants that may(estrict 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 bllure 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
commendngwork or recording our Notice of Commencement.
Signature of Owner/Lesseelcontractor as Agent for Owner Sig6ature of Contractor/License.Holder
i
STATE OF FLORIDA /�� STATE OF FLOtRID
COUNTY OF �� l lJU� ��� � COUNTY OF
The forgoing ir!strwnent wasacknowledged before me 0 The forgoing instrument was acknowledged before6.
20 by this,'day of 2019 by
Name of p on making statement Name of ersan making statemenE
Personally Known OR Produced Identification Personally Known�OR Produced Identification
Type of rdemificati n Type of Identification
Produced Produced
ry
(SignatuF f NotaryPublic•State of�IPrida) (Signatur f Notary Public-State of Florida)
I �^ "•••:;�o Fta?IlYNICOLfiNt4Rf l -t-. .�";:::�"ii, ttOLLYf�QfF 1 -
Commission Na.ST__ �lYCOt�dISS4bHiFF7. Commission NotC,t_�� '� eI}dY �ISS(ONPFF?
EXPtRES:Aitgust§,2078 EXPIRES:Aupstli 4
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION -SEA TURTLE MANGROVE
! COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE �
I RECEIVED
DATE -
COMPLETED !
Rev.8/2/17 ._.......—_—