HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL �INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: 4) r Permit Number: igoD_ - ocq
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mommeinimmomp Building Permit Application perfil.tt/n ®5 2019
Planning and Development Services St' Lu e Colafienr
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PIOPOSEDIMPROVEMENT'LOCATION.- .
Address: 94. 7 Ra4(7.1.1,n,�� EJQ / I /"t ' 4 4..t oc.e.cs
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Legal Description:�G��J )J/?a,7 ,.e. : a//37s /BF 424PrD S1.216I )6,2,0n;n5
Property Tax ID#: y�,0%//3-VOD/ -0 C)a 9 Lot No.
Site Plan Name: 1a:14.44t.r.i- ?.Cts Block No.
Project Name: Oil.41 %tai_. ?t4..._, 2—)
Setbacks Front - Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:,:; ,,,: --,,' -:, - :. _, ,,,,, ,,,:,,,. . -. -, „,-;A. ..;,,',,:,,,,.
.)104StrA..(;CCd A.4130A>14) eetaeLeo- I., -41-. ‘_.4.A..t.,.
CONSTRUCTION INFORMATION
Additional work to bhGas
rtormed under this permit-check all
;ha apply:
❑HVAC Tank [-las Piping ,J Shutters
rs QWindows Doors
Electric 0 Plumbing Sprinklers I I Generator Roof Roof pitch
Total Sq. Ft of Construction: SIF., of First Floor:
Cost of Construction:$4 8,S00, Ov Utilities: I Sewer El Septic Building Height:
OWNER/LESSEE CONTRACTOR '
.
Na rrt")..cle4.4
._/,(a,.e .it-ut ,kx.e. . N a me:`7}?I.c��rc.e�� >
Address: 6 O Company:/ u & G� �ccg.a)
City: �if,�,��.G4.� State: PA Address: £ Y Auro ,;/"I
4. , 4944.co - , /.0.z- B
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Zip Code: /6-:,:p, a Fax: City:. State: .744
Phone No. '77a- 6145: 0 '1'7'7 Zip Code: SI/94S Fax: 4/6/- Q 7"7 -7
E-Mail: Phone No. l( /- ^-7-7-7
Fill in fee simple Title Holder on next page(if different E-Mail:/!1 i(Ce e p'ot's - gill+-e.-4h i.e..Q, Cor %
from the Owner listed above) State or County License:E6/30D-5859
Si- d # ?9815
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S JPPLEIVIENTA CONSTRUCTION LIE LAW114f0RIVIgTICt
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,
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 prope . a Notice of Commencement must be recorded a • •osted on the jobsite
before the first inspection. If ou i tend to obtain financing, consult with lender • attorney before
commenc' : work or recor.ing y'ur Notice of Commencemen
ii I AL ABA
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Sig J" r:Yof Owner/Les- ontractor as Agent for Owner Si: /ure of Contract LT/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S4 COUNTY OF .5A KIT 1•-A-i-G
The fo going instrument was acknowledged before me The for oing instrument was acknowledged before me
this ' day of F- 119 , 20c) by this day of exue c1 ,20 I99 by
I,-U �Z pt,i Int c SEL fl2
Name of perso making statement Name of person aking statement
Personally Known V OR Produced Identification Personally Known LOR Produced Identification
Type of Identification Type of Identification
Produced Produced
LOA--14-11-040
(Signature of Notary Public-State of Flor'da (Signature of Notary Public-State of Florida)
Commission No. � :�t MONICACASANA I) Commie ,, .- MONICA CASANA
(Se )
:.; 'a GG (con s7� ; ,:, :Cammrssion1 G0 070973
-%L� Expires June 8,2021 y v.=Expires June 8,2021
f;liiw Bonded'Mtn Troy Fain korona ND-3857019 •40Vh° Bonded ThruTroy Fain Insurance 860.385-7019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17