HomeMy WebLinkAboutBuilding Permit Application ALL APPLICLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 , V 1 g Permit Number: / 'O y- a (p7/
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WRIONEW Du .', .,Building Permit Applicatio
PermittAiUnGg2D7e118rtnient
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X : a.'dAireAP County, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: .7-.,..'; ,..-, -; . - ,-- -:',„,, , ,.,.,'-• ' - _-'-,::.- .l'' ::,' ,-.-.--'_- . ,- - ',',:'-:.,,:' .-''
Address: ileVds MA_tprit._, had. jik - P.,,,,,..„)' „ Ji. 3J/9s-9, 44,..ze . 4
Legal Description: .0 7/8.5.,51 4/0,
Property Tax ID#: egg()70 iii- e66.2, ..., e:23a. 9 Lot No.
Site Plan Name: Block No.
Project Name: R.ti. Pat)1:19 da"rAPtA-46V4O/..) )1)4ri...,
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: ,--. ' ' • .: _,, - - , , : ._ - , -'' : ,„ . , -
Additional work to bru_Irtormed under this permit-check all-„04 apply:
FHVAC I I Gas Tank LGas Piping 1 Shutters 1:1 Windows/Doors
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Electric El Plumbing Li Sprinklers F Generator 1-- Roof Roof pitch
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Total Sq.Ft of Construction: S9,Et of First Floor:
Cost of Construction:$ gOa 00 Utilities: I Sewer Septic Building Height:
OWNER/LESSEE: ' :•--',. -,-, -•• -' :T 1:' '" ' '' 'CONTRACTOR:
Name i9h,tf;„4, , 1,, . , ohpeklut, ).: C. Nameht)4-0.0)-1,144,, /4f,iiit_i
Address: Pt . -.,h / ..7'4 ComparlrPA4.4.21, /,'hilif ..a/t PeilAiAtteLd• A. ..le.
City:-40-1i. f•Zw..) / State: Address:go 4. ee...jur iiirvidg, /0.3- B
Zip Code:Si/95 q Fax: City Lt P4,244.4...> State: ...44
Phone No. 9.207- 'i4J..g_33s- Zip Code:,...54/9"-Z6 Fax: 44‘,/-cz?-778
E-Mail: Phone No.144/-..1 0717
Fill in fee simple Title Holder on next page(if different E-Mail:fn;k4..epn;cht.- £lizeiliad e Co ril 1
from the Owner listed above) State or County License: Ed 13,22-5859
Sio- f, 975 I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: )(Not Applicable MORTGAGE COMPANY: )(Not Applicable
Name: Name:
Address: . Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ,,,y 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 propert 4, Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. I ou i tend to obtain financing, consult with ,ender or a - • ney before
commen ' irk o 7c. ding yr ur Notice of Commencemen .
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Sig,/a e of Owner/ -ssee 'ontractor as Agent for Owner Signat e of ontractoi/Li‘s - older
STATE OF FLORIDA • STATE OF FLORID'.1 /
COUNTY OF Si+ L/.01/E COUNTY OF ......,4
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The forgoing instrument was acknowledged before me The forgoing instruAt was acknowledged eff I'm
this2/ day of fityitcs-1-- ,2O1g by thiso2.7day of ,20/66 a
fh t: cil cag-1 Pr):cla rriiC*13-E,L- .7X.5 DE'
Name of persqa making statement Name of person making statement ,-,3
Personally Known V OR Produced Identification Personally Known ,-- OR Produced Identif
Type of Identification Type of Identification 1-
Produced Produced
/IAL-fkA,s 0..4) at,44,41/4-4/3
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(Signature of Notary Public- ' ' nature of 7 ary Public-State of Florida)
-Li, A..1,k)moNICACMANA
Commission No.e1C1 DI() LI' =,-: 1-,, cofroloan#G0 won Cc-nmission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED -
Rev.8/2/17
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