HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED' ��11
Date: / ,2 Permit Number: 0 �� y •
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Building Permit ApplicatEPermitting
2019
Planning and Development Services partmenBuilding and Code Regulation Division U my FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR: ��•.
PR®POSED IiN'PROI/EMENI' L®�A1"ION: Rom
Address: .2 0/1 Aal w h .4vc o4V e;c/Cc f 11!z!2`/-01",
Legal Description: _r1p /9/k„2 Loft SAF t; ( U✓3 / 5'7 -c242V
Property Tax ID#: 1%d- 70_3-001_57- 000-1 Lot No.
Site Plan Name: & A Block No.
Project Name: g2c .y/
Setbacks Front Back: /� Right Side:�_Left Side: N-13
DETAILS® W=02111
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C®NSTRIJ�CTI®'N I'N�FORIVIATI®N: r r �. w. �� m
itional iTvork to be performeddunder this permit-check all t at.app y:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors >.
_Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft.of Construction:; Sq. Ft. of First Floor:
p o ,
Cost of Construction: $a�� �O Utilities: —Sewer _Septic Building Height- o?S
.a,��'j m��`. C .}F�"�Er”'':.. }°84m� r'f ^&` ,_,. y 1 a '`",'�,rar {k :' � r,y ri .. "a'.�n L�,�•"`��„`�Y �rzi'4 p'. '.-yha;. � -H "fir ,
OWNER iHES8H{E M
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g �C®NTR/�CT®R ; m
Name o0eA eG.-A C /[c Cc Name: o e j e- ' C
Address: 4011 Ec�%v�h .4✓t Company: G a ti !lJ co
City: ig P:Prce State: F/ Address: /136 cf'l &,,s L -jIL Z
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Zip Code: G Fax: City: ez �o fir!! State:
Phone No. Zip Code: 3y0 901,r Fax:
E-Mail: &f hPhone No. 7V-
Fill in fee simple Title Holder on next page (if different E-Mail: 1jD Pr7, ^9"
from the Owner listed above) State or County License: S'c 4-A _QJ
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSl'RUCTIORI LIE*N LAW INFORMATIIO W k fat p ;
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Alot 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 nori-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 our Notice of Commencement.
Sig ature of Owner/ gent Lessee b =' atur of Contractor/License Holder
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qol *,�. 'Fri',*,,;•.
STATE OF FLORIDA STATE OF FLORID
COUNTY OF s �' COUNTY OF m-<
a x�n
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The f r ing instr t was acknowledged befo g m The forgoing instr nt was acknowledged befo gnW, j
this day of 2Q1� by` z Ko= this �'/day of 26/1? by
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(Name of person acknowledging) "' (Name of person acknowledging)
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(Signature of N ry Public-State of Florida ) (Signature of N&&y Public-State of Florida )
Personally Known ✓ OR Produced Identification Personally Known --' OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. /2014