HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ' `O
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F134982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIQN r a ; ,
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Address: d'70 ME M60 S�:j( 1- ?04 S}- tJAc P FI 3zi9$3
Legal Description: ( Oak — Gr RLd C 61 k qQ LO` Mc S
i f164YL, AtAd', 9S
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR1f?TIONOF 1NORK Y k
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ICONSTRUCTION INFORIUTATION � n x
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Additioila work toe e orme under this permit—check all appy:
L_IHVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
oa
Cost of Construction:$ ®Z,g00 Utilities: OlSewerElSeptic. Building Height:
IX W, fRJLESSEE v =P 5 �t k CONTRACTOR v x
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of ,«» .,,.r .�: ,�.,_ -..•�-, ...
Name I.otnA 01`I5enn Name: tAA%S IZ- ILncy
Address: a'10 kkC- MUSA Sc al G�-- Company: (Al Ap;g C°n,A,4 ,, niAq t LLC-,
City:R n fr 1,wct State: Address: '194 S44 5�i I Tir
Zip Code: Fax: City: -To-A %, 14W-e- Stater
Phone No. 77a- tJ-_,LI - 6W} Zip Code: ' 4LK53 Fax:
E-Mail: /nu a.c..-ke"1 Q_q McL, 1.e-^Yvl Phone No. Z7 a- Ga4n TRIZZ
Fill in fee simple Title Holder on next page(if different E-Mail:dna. h. A-
from the Owner listed above) State or County License: 0-kc is l(, 15
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN L4W`1NFORMATION xs " zXa to
DESIGNER/ENGINEER: _NotApplicable 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,
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
cornmencing work or reco ur Notice of Commencement.
Signature of r essee/Con ractor as Agent for Owner Signature on ctor/License Holder
STATE OF FLORID `` STATE OF FLORIDA,
Jt
COUNTY OF St 1'J�'e COUNTY OF �c� e
j The forgoing instrument was acknowledged before me The forgoing instru nt was acknowledged before me
this It day of Q-% Gtr 20A by this %k day of U`Q41 20!`1`1 by
61-0.-,, / 1�s R Pv�u�t — ���S Vora.ca
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 Ident' icat' n
Produced , C Produced
tAJ
(Signature of Not Public State of Florida) (Signature of Notary Pub c State of Florida-)—
Commission No. 4 t1 ;'�'1-a�'NF�•i� ��G."fF:;r..� .r
_ �11+= ?(Seal);k, 'C4 (Commission No. 51: Seal),, 4
p r til'.( 11�viJ"! `i Fc
?!lY GGPt41/1i;- 1U"$'.' FF92�97 a2 'Ii
Dr�cember 97,:fit '
ECF IfiES December 1 i,2099
146Y}3F'C 6' 3 Flon�a'utarysn�ce com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17