HomeMy WebLinkAboutBuilding Permit Application Ie/a9 911 ��
ALL APPLICABLE INFO MUST RE COMPLETED FOR APPLICATION TO SE ACCEPTED
Date: x0% /.1 ` Permit Number 110 - 01(26) "/
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ssuiva.rrg rerml=Application
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenz,Fort Pierce FL 345132
Phone;(772)412-1553 Fax:(772)452-1572 Commercial Residential
FERMI I APPLIC:AI 1C)N FOR: To Select from dropbox, click arrow at the end of litre
PROPOSED IMPKOVi_MEN I L 3CAI ION: - •
Address: /tie', , (den ". , 54 &ase 5'L$T, i S
Legal Description:
Property rax ID If: 01Ij2y-of/l 1D2c-Qa9/.5 . _ _ - — Lot No.
Site Nan Name: Black No.
Project Name;
Setbacks Front - Back: Right Side: ,Left Side: -
Ohl ARID UESC:RIPlICON f7)-WORK:
t Mc. 12,.1- tIlrtc_. j're. /yS4- r CAN7c- J fit.'/
CONST1JCI1J;.INFORMATION , .• •
• .ona wo 0 •epe •rm-• un•er is perm -c e a ;a i app
HVAC 1j,Gas Tank []Gas Piping ,_Shutters 0 Windows/Doors
0Electric 0 Plumbing 0Sprinklers El Generator 0 Roof rioof pitch
Total Sq.Ft of Construction: S .Ft,of First Floor-
Cost of Construction:$ r.2- °"� Utilities:Li Sewer ii Septic Building Height .
OWNER/LESSEE: CONTRACTOR:
Name P,, . •.• Frio b I - , r, Le Name: {r'�4��L LS_ 4A elk I?A c r15 --- ---
Address: 16-1* N of k313 t Jrv-e. company (u3-ra ni. l .r ST stems I n:c:
City __a anp(i .o_ick . State: Ft- Address:_ U(2l 5 £ E I % - r • i 0 r"
Zip Code:,-, ,J[¢to 1 _ Fax: _- city: o 1-T ,'t. L.s?�c Ste: f.
Phone No. 772,^'i Cv 5 -.1700 5.1 Zip Code: 3f452 f:aic_ 1V- d 85-1544
E-mail: Phone No. lI i 3 3 6-- 513 2-
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Fill in fee simple Title Holder on roxt page(if different E-Mail: L L $t a i r s s f a o 1-c G vn
from the Owner listed above) i State or County license: it CO 51$ (0
If value of construction Is$2500 or more,a RECORDS)Notice of Commencement is required.
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SLIFPLEMkN I AL CONS I'MCI ION LIEN LAW I NI-ORMA I IfiN: •
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: I Name: .
Address: - • Address:
•
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name: -
_
Address: ___ Address:
City: . _ City:
Zip: Phone: Zip: Phone:
_ . ...
I certifythat no work or installation has commenced prior to the issuance of a perrnk.
St,t.ucie,Counbe_makes no representation that is granting a permit letrilt authorize the permit holder to build The subject structure.
which is in conflict with antappkable Home Owners As5ociation rules.bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Oi.mers Assodation and reijiew 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 arid St.Lurie County Amendments_
The following building permit applications are exemptfrorn 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 iobsite
before the first Inspection.If you intend to obtain financing,consult with lender or an attorney before
commencin: work or recardin- our Notice of Commencement. ,--
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1 Signature of OwnerAessee;Toritractor as Agentfor Owner Signature of Contractor/License Holder
STATE OF FLORIDA L STATE OF FLORIDA
COUNTY OF 1.).7, (/ r;C:I e... _ commr OF •,,,) t k,e; ,, •,..•:.
The fortoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this AI day of OCT , ZO le,bv this act day of OCT _ ,20 a ,by
Cu r b e" v 14 in moil .S" . : Lir-1 5 Q;1 iii tfrto Yi 5
(Name of person acknowledging) (Name of person acknowledging)
L.-if ,... —...--)di/
(Signature of Notary Public-St4te of Mia) (Signature of Notary Public-Stoteof Floridel.
, .
Personally Known OR Produced Identiffcntion Personally Known vOR Produced Identification
' Type of Identffication Produced Type of Identification Produced
A L.' 17.77 /i -0•:.Piritf, CAPErit*.7..‘IlS^ SSII
commission No.G a C ', ----1/63 : .4..1' 0115101Ea:"`,•. mission 1.40.0-05 0 clati 70 !:-.• II• MY rr-k.-' .:'. 1352546
- ::-. , - MYCOIASWIONS t,'moo * .-' ,* - . ..
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or •' asmvilliviitkelptlattelehitces
Revised 07715/201.4 . , ,sil CCAIESSIONSCOOSS40
EVIRES:4114.221
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REVIEWS ;
FRONT ;I ZONING 1 SUPERVISOR PLANS i VEGETATION 'SEA TURTLE MANGROVE
COUNTER 11 REVIEW 1 REVIEW REVIEW I i REVIEW REVIEW REVIEW
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COMPLETE 1
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