HomeMy WebLinkAboutBuilding Permit Application h
TALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11��
Date: ® S Permit Number:
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Lnum WTI
Building Permit Application
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
FPROPOSED IMPROVEMENT LOCATION
Address: D 14.i.1s-L�
(Legal Description: D
�PropertyTax ID#: Lot No.
Site Plan Name: Block No.
Project Name: oaffa o Oli"L(_"
Setbacks Front Back: Right Side: Left Side:
;DETAIL- DESCRIPTION OF,WOK
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kCONSTRUCTION INFORMATION. {
itonal wor toe e orme under this permit—c ec a appy:
DHVAC E]Gas Tank Gas Piping _Shutters 0 Windows/Doors
2EIectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 860. Oy UtilitiesSewer OSeptic Building Height:
by ER/LESSEE.-. _`tCONTRAGTOR:
__.
Name7"nZ�_ . _Q. 4• c..G4Ae , —yYIa.Q�c.au Name:�7"zr_A� /`Ziaev ..��11
;Address: /8 Gt/Lca� JL..G�-tom Company: c� -c..
,City,: Ll rt.L�iY) x� State:_y Address: � 3 /02-p
Zip Code: //7!Y 3 Fax: City: Jyd ,t.PJt� Stater
Phone No. Zip Code: 3/411H� Fax: ,/G/- '�e
E-Mail: Phone No. 7/6/--Q777 70-&9'9V
Fill in fee simple Title Holder on next page(if different E-Mail:mike °LCDM
from the Owner listed above) State or County License:E_;Li/300 S 8 159
S-Le 87-5
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: )g,'Not Applicable
Name: 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:
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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
I WARNING70 OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
Improvements to your pr�*rng�y�lur
Notice of Commencement must be recorded and posted on the jobsite
before t ectiotend to obtain financing, consult with lender o attorney before
commencin work o Notice of Commencement.
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Sin re of Owne Lea/Contractor as Agent for Owner Sig a ure of Contra r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .SA N-11- COUNTY OF .;54*1"1—
The fo oing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this day of 0�'U r5r ? 20 1?' by this day of 0e�To r5� ,20Ig by
Name of pprsgp,making statement Name of persor Aaking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signatur - �o Florida) (Signature of -
CA 6,0L•S9me 1 Awl `ciao'••
MONICA auernsu uls 6a
':Commission#GG 070973 .•:d°••'••�''•
� Commissi �i�l un 21 (Seal) Commission N IZOZ'8�npsand
Expires ��g00.366.7019 £16010 00#uolsslwwo0
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REVIEWS' FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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