HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ;� O Permit Number: cc -
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RECEIVED
Building Permit Application NOV 0 2 208
Planning and Development Services
Building and Code Regulation Division ST, LuCIc County, Permitting_
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
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Address: V a. 111 _A WO W A
Legal Description: UyAK'1� V 9�Ia1(/1� Y/�lk Al�UA k AN �10k 9 NSW
Property Tax ID#: 111 ^ 0022' - 2i�10 - 5 Lot No.
Site Plan Name: kl (A Block No.
Project Name: � j
Setbacks Front 1v k Back:_�_Right Side: Left Side:
kp,ETAILED DESCRIPTION OFWORK '� ;AN � a �
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CONSTRUCTION INfORNIATION n°
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Additional work toe n)erFo—rmed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
0Electric 0 Plumbing Sprinklers Generator 1:1 Roof Roof pitch
AL Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ ��d,o Utilities: Sewer Septic Building Height:
OWNER/LESS;EE ` `,. f s °CONTRACTOR
Name *� Name: � h
Address: 41 fl Company:
City: State: R, Address:
Zip Code: 791tI�_J- Fax: City: State:
Phone No. 172 - U C1 CQ " 2 ! J 1 q0+bb1_9l$J Zip Code: Fax:
E-Mail: bwe+w 2( Phone No.
Fill in fee simple Title Holc1J on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUP�PLE�MENTAAL CQNS�TR�UCTI N L�E'N�lAU1 �INFORMA�TI01� f
F '4* 7" '� '2 Mt.
DESIGNER/ENGINEER: of Applicable MORTGAGE,COMPAN : Not Applicable v.a..
Name: Name: Ui11A"Winae ,� ff(A,Ulsl.�
Address: Address: Pp P)nlc 1,y0N
City: State: City: pvyyiv%!1 State:ALI—
Zip: Phone Zip: o%6!14 - Phone:
FEE SIMPLE TITLE HOLDER: _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 thepermit 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 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 work or recording our Notice of Commencement.
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Signaturef caner essee/Contractor a ent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fDrgoing instrum nt was acknowledge
refore me The forgoing instrument was acknowledged before me
thiQL day of W 8 V 20_W by this day of 20_ by
Gwevlew'l EjQlexi
Name of person making st ement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif' ion Type of Identification
Produced (, Produced
Piz'
_
(Signature of Notary Public-State of Flo 'd ignature of Notary Public-State of Florida)
�p,�jN S. NIELSEN
Commission No. °'�YPUB��,Sta�eEf Florida Notary Pub i mmission No. (Seal)
*'- Commission # GG 20748
P My Commission Expire .
12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17