HomeMy WebLinkAboutBuilding Permit Application i
.SSU PLEMENTAL ,0IVSTA4U BION LI�ENLAW INFORMr4TI0N
DESrGNER/ENGINEER., _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Add'�ess: Address:
city:1 State. City: State:
Zip: Phone Zip: Phone:
'FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Na e: Name:
Add,-ess• Address:
City., City:
-Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR'-.AFFIDVIT:Application is hereby made to obtain a.permit to do the,work and installationas:indicated.
I certli`that no work or installation has commenced,prior to the issuance'of a permit.
St.'Lucfe:County makes no;representatiori:thatisgranting a ppermitwill authorize_the, erniit holder to build"#he.subject atructure
which is in conflict with'any applicable-Home Owners Association'rules,bylaws or arid,covenants that may restrict or prohibit such
structuyre .Please consult with your Home Owners;Association andreview your deed for any restrictions which may apply.
In consideration,of.the:granting of this requested permit,I do,hereby agree that,l will,In all respects,perform the work
in.acco�`dance with the:apkdved%plans,the'Florida Buildinif6des and St.Lucie County Amendments,
The fol owing building applications are exempt from undergoing.a full concurrency review.room,additions,
accessory structures,,swiniming pools,fences,wails,signs,screen-rooms and accessory uses`to another non-residential:use
WARNING.TO OWNER:Your failure to Record;a Notice of Commencement mayresult in;yaur paying;twice for
impr9vements to your property.A Notice.of Commencement must be recorded and,posted on the jobsite
before the first inspectltin..lf.you Intend to.obtain financing,consu(,twith-lender or'ari attorney before
commencin work or recording our Notice of Commencement.
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SOK lure of Owner/Lessed/Contractor as Agent for Owner Signature=df Contractor/License Holder
j STAE OF FLORIDA STATE OF FLORIDA
COL�NTY.OFkc COUNTY OFS-� c • ^
The f� r oing instrument was acknowledged before.me The forgoing instrument was acknowledge4.4efore me
this day'of. 'Sc,n'� '20ayby this,U-day of ��h w�-�;1� _ .20 21 by'
Na 'e.of person r6kirigStatement Name otpemon makingt.aterrient
Pers:nally Known. 1-�. ;OR Produced Identification Personally Known_ v�OR Produced.ldentification
Type of identification Type of Identification
Prodiced Produced
iliv
(Sig ature of.-Notary P ` �P :Fj�[jp�ublic-state of Florida (Signature of Notary Publ $ �EJorl��.
c ? n o a y Public State'of Florida
Cgmigslon#FF 216951 • ` „ sslon#FF 21695:1
Commission No. '� �' M d �AExpires Apr 5,2019 Commission No,
I e o y. , M t Explres.Apr 5.:20 9
Bonded through National Notary Assn �''� P„„` Bonded thraigh Natlonai teary As A
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RE1{IEWS FRONT` ZONING SUPERVISOR PLANS VEGETATION SEA'TURTLE MANGROVE.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
2DATE
OMPLETED
Rev.8j2%17
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ALL APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
. J o /
Dater- / q Permit Numl:
- RECEIVE®
RON
Building Permit Application JAN 0 9 2019
PlantIng'and Development Services
PH.. ngandCode RegulationDvislon Permitting Department
2300 Virginia Avenue,fort Pierce-FL 34982 ,, �,,Cie
Phone:(772)462-1553. Fax:-(772)462-1578 Commercial eS�{}-OnWnt Yr FL
PER MIT APPLICATION FOR To Select from dropbox, click.arrow:at the.end of line
Two,�05ED�1(1(I'PRO,_ M11 IIOCATl0 t �
�. ,_ � rte. . s_ _ _ �_
Addrel s:µ 3 cZ G J
1 '
Legal Description:
111 p (
L 3
a-ty Tax 1D#. i3_ n Lot,No.
Pro
Situ Pllan.Name: Block,No..
Project-Name•
Setbacks Front Back: Right Side: LFeftSide:
a .
DETg 1_DSCRIPTIO`NOF�°WORr Y a E
.i3:.. '
�-� •►�` . •i Tel:914Ce 7 cj�
CONTRUC,TIONINFQRMATION
ssdzW:b ,M&a+ ck..r`-a.r:a.G ..,h_ _3:b
tonawo,r= -to�E26as;Tank
,orme� unert� spernit=cec�a = ;appyt
EIHVAG Gas Piping _Shutters Q Windows/Doors
CElectric plumbing Sprinklers Generator 0 Roof Roof pitch
Total q,.Ft of Construction:
$ ..Ft.of First-Floor:
.Cost f'Construction.$;' (�ECC7 utilities: ❑;Septic Building Heights
®1l 'Elf=SSEE t 4CONTRACi�OR
Na_ M, 1 c e r Name,
Com an al. ' r 63 .� .. ._
Address: �G -, p y � �a.: n_ � -•.
City: State: IJL Address:
Zip Code:3 y Y'C'i Fax: city: e Stater
Ph6n'.-No..5. �Lk_— 57dc7 Zip Code: 3 t4'9-,�57A Fax: I 1 e> 7
E-MH: Phone No.
Fill in fee simple'Title Holder on_next page,(If different E-Mail: C ,y 1�'�-• r r.y►� �- ,t l�� �sr��'t'�%
from tthe.0imnee listed!above) State or County License: cke 1 -36s f
I f
i r
If value of construction is$2501)or more,.a RECORDED Notice o0tommencement is required.
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