HomeMy WebLinkAboutRevisions OFFICE USE ONLY: p /
DATE FILED: PERMIT# J l
REVISION FEE: �� RECEIPT#
PLANNING&DEVELOPMENT SERVICES
RECEIVED . BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 349625652
SEP 0 7 201$ (772)462-1553
ST.'Lucre chunky, Permitting APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCA'T'ION/SITE
ADDRESS: j
63
L,- C�i01i. Z kti CYt rte,`
DETAILED DESCRIPTION'OF PROJECT
REVISIONS:
��a.n• T S.S ry
CONTRACTOR INFORMATION:
STATE of FL-REG./CERT-#: G S`4 ST.LUCIE CO CERT. #:
BUSINESS NAME: A-ir csoNAro G e
QUALIFIERS NAME: c N rV 'S
ADDRESS:
CITY: at-r e STATE: F/ ZIP:_ 35 F2
PHONE(DAYTIME): )V- G 4"&S FAX: 222 — 6
OVMRIBUILDER INFORMATION:
NAME: VN
ADDRESS:
CITY: 3-e,".re IV "NATE: E ZIP:
PHONE(DAYTIME: `iS % 3`94 �- ' S/ FAX: N A
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC:9/2310.
Revised 06130117
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ALL APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r +
Date: Permit Number: I
Building Permit Application SEP 0 7 2018
Planning and Development Services ST.'Lude Col i-Ity, Permitting
Building and Code Regulation Division
23W Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
d
Address:
Legal Description: 0�-t Iri 0\ A c ti C 1 AN jfra _ e t 4
5 � tir<C.0r, i`ar �2'Z� 3 OV 6 6G1IOU _713') 766--16GI 2i(44 .
Property Tax ID#: Li O k- to (401- " 0 7'3 Lot o.
Site Plan Name: Bloc No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
. ' Ram
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E
Additional wor oe e Orme un er t s permit-cneck a apply,
014
1
HVAC 13 Gas Tank ❑Gas Piping _Shutters ❑Windows/Do rs
ClElectric L�Plumbing Sprinklers Generator ID Roof Roof pitch
Total Sq.Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ 3,Zgo Utilities:oSew' er OSeptic Building Height
EM®R Will No=
Name 3 A DvfName: 146Wfnn'S
Address: ` 6�5 Me3AW Company: A.r c n�ra d ,t v; �rA h LLG
City: Tt)ren $eaa,cl, State: FL Address: Sq 15 rorIP t, k u
Zip Code: 31AgV 1 Fax: City: N,;� R;;L1r ck S ate:
Phone No. qS Li iAp -1 1 6 W Zip Cade: 3 q Z Fax: -T7I- L6 t1-_G613
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: qX U N'FF 1� @ A60 o E C Q�
from the Owner listed above) State or County License: CA Gl 1 415
If value of construction is$2500 or more,a RECORDED Notice of Commencement is reguired.
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Mi few"
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:' Not pplicable I#2
Name: Name:
Address: Address:
City: State` City State:
Zip: Phone Zip; Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not pplicable
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 Installa tion 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 sub ect structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict r prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may pply.
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 hon-reMder tial use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying wice for
improvements to your property.A Notice of Commencement must be recorded and posted on t le Jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney t efore
Commencing work or recording our Notice of Commencement.
AZT
GZ�t � d
Signature ofOwner/Lessee/Cdntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5.+-Lyc 2 COUNTY OF
The fo Ding instrument was acknowledg�gj before me The far sing instrument was acknowledged be re me
this or day of Suet-ilcj,\W _,2Q I 0 by this B'��day of SNiJ16%k e Y 2d� by
Ro6�r'� �.... ���ht5 }'O�t�r�''1.... LJtI►+S
Name of person making statement Name of person making statement
Personally Known_/Y_OR Produced Identification Personally Known _ OR Produced Identification
Type of'Identification Type of Identification
ProducedProduced
" p`•f PATRICIA A.GARYON ,,,,,,,,,,
L-1
Y �y`,,- PATRICIA A.GARYON
.o' Diary Pudic-Slate of Florida Nat ubflc-State of FI ida
r'
Oct 13,2018
{Signature of o'' , o-St '�18I1iQI�FJ 133580 _ (Signattte' -'Puhiilrn�t tFr`ttia�6
Bon d rough National Notary Assn. X33 'F%„'°;`
+ ,+ Bo ed Through National Notary Ass
Commission IV l ea Commiss(`b
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLEMANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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