HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (
iiPermit Number: ( 0*(
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COUNTY \ RECEIVED
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MANNIMMIEMIMMEr Building Permit Application NOV 14.2018
Planning and Development Services
Building and Code Regulation Division Permittin5 Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. hide County
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 ,
Address: /r9,9Q, NWMer`ner- ( L P4., r;47. , F/ 3YPO
Legal Description:nbr; e/ j/,//aje /4.4,-A,..., P.df/e 1P/S v Olr, l'-/- PS
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Property Tax ID#: YypS' C &?-0O.?7- 000"4- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: - , Right Side: Left Side:
DETAILED'DESCRIPTION OF WORK <'`
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eee)AClj I gn 7 ar-�e- _bow- L.;kP -�, 1, Le - wf mta.,., ,,./)
CONSTRUCTION'INFORMATION :
Additional work to be erformed under this permit—check all that apply:
El HVAC I1 Gas Tank EGas Piping _Shutters .❑Windows/Doors
❑Electric El Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ (9-30 , v v Utilities: Sewer El Septic Building Height:
„OWN ER/ILE.SSEE: . CONTRACTOR:,:'
Name• ) 61r,N'.w, Name:J4b,-1: /Irez
Address:l a 7 f ;2 /U v✓ (1/1 Or .t hec C-f_ Company: P--f: Ch c ' ( 9f ,bOO'CS
City: P/X /ri. Cr'(-y State: FL Addre�s: )p (7 5-1-u 1" l/j k...;N 4 vL'
Zip Code:3y9,0 Fax: r City:4)0(4- Sf. L t&t State:_PL
Phone No.(?7,a) 33(Q -Ire5 Zip Code: 31/P53 Fax: �3
E-Mail: Phone No. (,'7//' ) 370— O Q/ T /&
Fill in fee simple Title Holder on next page(if different E-Mail: jot o e-I ed/>, q )(a go. Goin
from the Owner listed above) State or County License: a-85-17-3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INF_ORMATION
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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: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: ,i
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. Ii
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,per-form 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 your Notice of Commencement.
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Sign/re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA . STATE OF FLORID
COUNTY OF `� I C`Q COUNTY OF wet
e
The forgoing instrum nt was acknowledge before me The for oing instrument was acknowledged before me
this i T day of dU 17 t ,20(4 by this /I day of Al b\/ ,20,[ 6y
Jo(,►- 'y UTtr l'ox; Lyhr) st e-z
Name of person making statement ,./ Name of person making tement
Personally Known OR Produced Identification Personally Known OR Produced Identification-r
Type of Identification Type of Identifiction
Produced V..� __D�
1L, Produced iL,
,•�� YP6', E L
4
:2 9V.-.State ofLEN.VAUGHN ,��;R�P�.,, ELLEN
LI FfCS it�E dflPkYri�ll tar(Signaturj 'J? .Qin t�$�6f+F161 d200079 (Signature of, r ui� y Public ,
,,paii°`� y Commission Expires ��11f
ommission #GG 270079
October 22, X321 11 7:40F tss',' My Commissi pires
Commissi Commission N _ •October 2�g
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW,i
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17