HomeMy WebLinkAboutBuilding Plans All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A CEPTED
Date: gLqoh Y P rmit Number: 39
0 F
�01 Building Permi Application
Planning and Development Services
(h Building and Code Regulation Division C (.,0
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: ,
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011,E W,1210.
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Address:
Legal Description:
Property Tax ID#: _341 L4 Lot No.
Site Plan Name:
Block Na.
Project Name: 71)U
Setbacks Front Back: Right Side: Left Side:
41-j–
FARE=
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11 WIM-1411 MA A ON~V&ASK
muuttiuriijiworKlIOE)eper-rormea under this permit–check all
Y__Mechanical —Gas Tank ^Gas Piping Shutters WindowsJDaors
Electric —Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of first Floor:
Cost of Construction:$ Utilities: Se er Septic Building Height:
Amew C T.
NameU_)U.no '1Name:-Am4ek 4kc Opa-1
Address-
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Address (1 bxl!_Z� miox
Zip Code:.
Fax: City: _C�Lc 4-e State:
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Phone No. Q(Q(6D?,!>r JaO-)– a Zip(o f!�c;� z Cod Fax:
E-Mail:
Phone J d,
Fill in fee simple Title Holder on next page if different ;0 LJ/-A
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from the Owner listed above) State oCounty License:
if value of construction is 2580 or more,a RECORDED Notice of Commenc ment is required.
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r SUPP I - EFAt CONSTRUCTION-LIEN lAW�N a 'MA�T#ON>
DESIGNER/ENGINEER: _Not Applicable MORTG GE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDIN COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
t Zip. Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtaia permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of permit.
St.Lucie County makes no representation that is granting a permit will author ze thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaw or and covenants that may restrict or prohibit such
i structure. Please consult with your Home Owners Association and review you deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree th t I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Luce County Amendments.
The following building permit applications are exempt from undergoing a full oncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and ccessory uses to another non-residential use
t WARNING TO OWNER:Your failure to Record a Notice of Commen ement may result in your paying.twice for
l improvements to your property. A Notice of Commencement m st be recorded and posted on the jobsite
x before the first inspection. If you intend to obtain financing, con ult with lender or an attorney before
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commencing work or recording yoyr Notice of Commencement.
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Signature Owner/Agent/Lessee Signature f Co or/License Holder
STATE OF FLORIDA STATE 0 FLORID
COUNTY OFA-� l�.iL'A�P COON OF — Imo- c c P _
The forg i.,ng instrument was acknowledged before me The fo ng instru ent was acknowledged before me
i this May of 20aby this ay of 201eby
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(Name of p rs n acknowledging) (Name of ers n acknowledging)
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r (Signature of Notary Public-State of Florida) (Signatu a of Notary Public-State of Florida)
Personally Known OR Produced Identification Personall Kno
Type of Ide t i I Type of I entifi tic1' "0uced nFRnRA
DEBORAH RUSSELL =2;�;`= Notary Public-State of Florida
Commissio Pl��°c s Notary Public-Stap3@bflorida Commiss on No Commissio�&MY9630
S.Na sCommission # FF 179630 %;F OFFVo •'� My Comm.Exp ,2018
i �iFOFFI�pMy Comm.Expires Nov 30,2018
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