HomeMy WebLinkAboutBuilding Permit Application All APPLICAByE INF?NEST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: y l V Permit Number: 1/ -, D W17
I
RECEIVED
C & MT NOV 262010
F L O R 1 0 Fk --.--r - .;
Building Permit Applicatiorit►ng Dep„nm®nt
Planning and Development Services St'Lucie�vunRy
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1/
PERMIT APPLICATION FOR:
PROPOSED IN m 9901 OK
UEMENT'LOCATI® '.' - . -,.. 3 ,',, • . :',.;• . ” --, , . ..4,,
Address: 9 -/ 01 Ops ailti a Pi?a10 i - c7Y-9,,S
Legal Description: LO] [7 I 81 c,k o1) (ate wool Pail OrjtJ cJ
Property Tax ID#: 130 )-- (60/3" 01 (0 - QO(j/ I Lot No. `9
Site Plan Name: Block No. cao9
Project Name:
Setbacks Front Back: Right Side: Left Side:
R AILED DE�SCRIPTION� WORK° F , a! . .. $t .
na, �
,, / u arrun prpper as shown on st�'Yett t-Th 1 s1c jlo
�- r
C�akso [Daus wi 1 lean n 31(1 o ' pro e , <�
mini .24 " Sides $0 n lair ick Roll l' A/- �i11( Mr
(oaks --f UlrU P faa1e 1'u on ck ,8 in4-
CON-TRUCTIO L 1NFORMATIONo :` �'$' ' ® `era.
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof 'Pitch
Total Sq. Ft of Construction: J91/ Ln 11- Sq. Ft. of First Floor:
Cost of Construction:$ /, 30 Utilities: Sewer Septic Building Height:
OWNER/LE=SS% ° . ; ,... , 'I: . . ,_. ,CONTRACTo Ro . . . , .,
Name f Carr !N (��E�l_,$) A Name:
Address: 91)1IAA S1I intro IV Company: -. I
City: 77YZ12 State:ft Address:
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Zip Code: ' / vFax: City: State:
Phone No. ti KU- AoIpp -e, 1g• Zip Code: Fax:
E-Mail: in rl N- aSpa{, y4 hVl2- (on") Phone No
Fill in fee simple Title'H'older on next page( if different E-Mail
from the Owner listed above) State or County License
1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.S : PPLEM BONS IJ�CT OE 0I OLZO 0 ,4-(*-CAMAY A ,° - . u .. .
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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:
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 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,
accesso structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
W NIN TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
i rovem nts to your property. A Notice of Commencement must be recorded and posted on the jobsite
b fore the first inspection. If you intend to obtain financing, consult with lender or an attorney before
ommen . g work or recording your Notice of Commencement.
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Signature o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5V L u_ci e_ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this alSday of X.Tx,e Kr ►reJ , 20 II by this day of ,20 by
rnrk6 l L 0) pn1`f
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced f-1._Di, Produced
.11`A) EL_
(Signature of N -.-.5.'P 6o•,�`£5 a�PiiNcitho ar Public (Signature of Notary Public-State of Florida)
ommissinn #GG 270079
F":4 My Commission pcplres
Commission No '4'1111 ®otobor 2$g2b22 Commission No. (Seal)
1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17