HomeMy WebLinkAboutBuildling Permit Application Jan 30 2019 1:26PM HP Fax page 3
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All APPLICABLE INFO 1 4T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: /-3 ... iI1"i . Permit Number:
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-,:r=4"10,.....-,...".=.4......`1=S1/1.,.....7.-1.341 Building Permit Application
Planning and Develop .. 1 Services
Building and Code Reg ,in Division
• 2300 Virginia Avenue, ',! T,Pierce F 34982
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Phone: (772)462-15', : I tax: (772)462-1578 Commercial Residential
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PERMIT TYPE: 1 jj 1 '
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Address: 3 .4 I 1 6 i'V e(e,fr, li,i,oly
Property Tax ID#: lir fr it..SV i/ ,CP C, /ea ? • Lot No.
Site Flan Name: /9..,:1 , irin SI di 11,03 e... / 11 e-iet z 7 11 e,z., Block No.
Project Name: • 1 I I
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Additliona I work to be p.I.:rmed under this permit-check all that apply:
• /Mechanical1 'i. Gas T nk Gas Piping Shutters Win dows/Doors
• -Electric I I 1 PlumIhng _Sprinklers —Generator Roof Pitch
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Total Sq.Ft of Constructill i Sq.Ft.of First Floor:
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Cost of Construction:.$ i 1 . 4 ', '- Utilities: _Sewer Septic Building Height:
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Name iffralgilitifflO . Name: o 9 eit• •
Address: 3, )0/1 .ti ! ! • WA Company: fi i c r en) r \
• City: .t.,,,.'ilsammanadii .11.. .. • . State:„H Address: ...1-it ALS- S i )%Per 6 01)K Or I
Zip Code: 3 4P2 III , Fax: City: Fri el 44-c.,t, State: F
Phone No. 'S' - ?Jr! • S - Zip Code: Y11-7 n Fax: ) 2- y6i7-613
• E-Mail: • I I ; • Phone No 1).,2 - 61,-. 49 6 ,..s-
Fill in fee simple Title ill,Rlicier on next page(if different E-Mail O.% t cep- )r•a) ac• t'_Yu )1 av 1 e• P,IN
from the Owner listediI -.1,,Sow) ' State or County License 4ArA C 14#1.411N-e7.41-
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If value of construction is i i.4 or mi re,a RECORDED Notice of Commencement is required.
If value of HVAC is 0,soa ' ore,a I ECORDED Notice of Commencement is required.
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Jan 30 2019 1:27PM HP Fax page 4
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DESIGNER/ENGIN: Till Not Applicable MORTGAGE COMP,NY: —Not Applicable
Name: 11 Name: I
Address: Ell : Address:
City: 11111111111111 State: City: State:
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Zip: " it ,e Zip: Ph.ne:
FEE SIMPLE TITLE * I3ER: Not Applicable BONDING COMPAN : _Not Applicable
Name: 11111Name:
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Address: Address:
City: illiniii City:
Zip: ri I re: Zip: Pho e:
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OWNER/CONTRACi ID * AFFIDyIT:Application is hereby made to obtain a permit to .o the work and installation as indicated.
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I certify that no work or I eilation liras commenced prior to the issuance of a permit.
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St.Lucie County makes n• -presentation that is granting a permit will authorize the permit older to build the subject structure
which is in conflict with . ,applicable Home Owners Association rules,bylaws or and coven nts that may restrict or prohibit such
structure. Please consult your Home Owners Association and review your deed for any estrictions which may apply.
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In consideration of the g .1 ihg of th's requested permit,I do hereby agree that I will,in all r-spects,perform the work
in accordance with the a,i. •tied pia S.the Florida Building Codes and St.Lucie County Arne dments.
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The following building p,4 applica Ions are exempt from undergoing a full concurrency r- iew:room additions,
accessory structures,swi 1 ing pool ,fences,walls,signs,screen rooms and accessory uses o another non-residential use
WARNING 0 OWN: ' Your fa lure to Record a Notice of Commencement may -suit in your paying twice far
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improvements to youl ..ropert .A Notice of Commencement must be record-d and posted on the jobsite
before the first inspe. t'n.If yt II intend to obtain financing,consult with lent er or an attorney before
commencing work ori idordin: your Notice of Commencement.
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Signature of Owner/Le 1,,•,(Contra or as Agent for Owner Signature of Contractor/ icense Holder
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STATE OF FLORIDA 1 ' STATE OF FLORIDA 1
COUNTY OF k c... COUNTY OF ,.j,' Z. v.<-i C_
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The forgoing instrumen Z ackrio ledged before me The forgoing instrument as acknowledged before me
, this 30thday of aXrN. 12 202,Zby this_, day of .1 rL r 20 ii. by
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Name of of person making" 1 :tement. Name of person making - atement.
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Personally Known ,,i_ QR Prod ced Identification Personally Known OR Produced Identification
Type of Identification 1 111 1 Type of Identification
Produced , Produced
Gomm. . 1
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14,0,11011.4“ , #86,270402 ____,
41i _.:6'1-'-,...''•*.t...._601.A .L....,, -^ ; rear• - -- --
(Signature13"14"";411111-'•";;VT:-,77-4,Z7777=1 (Signet 1 - • ,, .471.",77 ,.... . .#41.,..-', ,i. )
.., III ' '7 ,.-'.."..- OP•- .: October 23,2022 I
Commission No. / IP . - & (Seal) Commi•; .1.1.-iri..,4.-.1.;... .1,,. ....)../."• •;
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REVIEWS FRO Pitil ZONING SUPERVISOR PLANS VEGETATIO SEA TURTLE MANGROVE
COUN i:'1 REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1 I I
RECEIVED 1,
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DATE 1 11;
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COMPLETED
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