HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10^ la' Lc' Permit Number: 1 FIO --09)
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::----- Building Permit Applica ion -u uumiwiad
Planning and Development Services 810Z g 1 130
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)4624578 Commercial Re ia3llia33111
PERMIT APPLICATION FOR:
PROPOSED INI?R@V@MENT OCATIONE--.
Address: P ) 1 3 1- i OL
, 9 5-
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Legal Description: )"\--1 I„ 1 S I 1...)e S't4,6 e P6---1/' 2-6'r t e
Property Tax ID#: esa.Li- c> 3 - (2 a ).- ,-. oole - 000 — 0 Lot No.
Site Plan Name: Block No.
Project Name:
• Setbacks Front Back: Right Side: Left Side:
. . . . . . , ,
IMA LEM DMR IPTICROF WORK1 °-..i' . - - .--- - ',--• -. '. .---, ' '',..4'
lir grei e/i nj /00,414,r merit,r- 146 .200 itr-r fnezteel-r)-4-A .
' 4 0%1/a, k e-ct.d Set-v I ce ei 14 de csroct-d-Fel
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COW TR Cu ® FOMATION
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Additional work to be performed under this permit-check all that apply:
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Mechanical Gas Tank Gas Piping Shutters Windows/Doors
_
_ _
— _
j Electric - ___Sprinklers Generator Roof Pitch
_ — —
_
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$. 03000, DO Utilities: Sewer Septic Building Height:
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Name ,tifitiny',,.K7.6: i L-- '; ,,17. -- Name -•MOTTFAI ...ij,k,„/ f".._. 5"3
,--
Address: D--0 r3,-ive 0 ilix_ v/ x rt.:, Company LY '-',e1,9:9.-4; _ )NC
z. ,,r •,,,,, ,.. . . "*”.t`1:4:,-
City: c'T" 'el g=c-t- State: Fl." Address `2-4/,.. "- AtAt...- 1704-
Zip Code:3€114/b Fax:77)--/6 / /gr.? City: Ai6 State:ri-
Phone No.773-- e20/' 730 -(5' Zip Code: 3-;1477 Fax:
E-Mail:g17-/-ea6/1) j4 0 6.-- iltinit Phone No (5-4/) 3/? 2V
Fill in fee simple Title Holder on next page(if different E-Mail 2345 a/6-0444Zi1( 01,11/=',•--C<A-1
from the Owner listed above) • State or County Licenseo2W5'g Eg 130/11749
- )
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
. ____
SupPLEI1tlf~ A L CONSTRUCTIiCI LIEN m $@R 1ATIO to 1-:-.'-..: _
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: -- .T-:'- i Address:
-City.,7..., i•, ,.. :, . , ._ State: City:
State:
`:Zips;: .-Phone i Zip: Phone:
FEE SIMPLE;TITLEHOLDER: ; _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:_ Address:
City, ,' �.. .. ',.i.lir t City:
4Ztp:,::: y _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-arid 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 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 wor or recording your Notice of Commencement.
Signatu a of/qw -r/Le .ee '.n ractor as A:- t or Owner Signature of Contractor/License of er
STATE OFFLORIDA , rp, STATE OF FLORIDA
COUNTY OF Tfvd,,p,(\.) \\R4. COUNTY OF -(W_ ri eco c h
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this gwday of ON-b\e-cr ,20 ( by this 1 54"day of 0 c- I. , 2011S by
MGA-a-11/2. 1.0 34ru .5 Ive 5
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification L
---Type of Identification— - _ Type of Identification - _
Produced FC DI_K -SI)-51-1- -6 Produced A- Ut`71/4>er L`c wtS,
(Signature of Notary Pu•IicSYateofEJor�l�-- — (Signature of Nota Pub'`; ,, .,-
,,1'.4%""'t, DANIELLE L HARRIS ? NOTARY
Commission No. m ":1 Notary*DHd}•State of Florida Commission No. _,SAerr-STATE 1° 'IDA
f
`:;���T"�� Commission q GG 256950 ��r"'Contmtl '�70
uF,n,' My Comm.Expires Sep 10,2022 Expires 11/18/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW • REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ,
RECEIVED
DATE
COMPLETED
ev. 8/2/17