HomeMy WebLinkAboutPermit Application Fitzsimmons 3-11-1920190309_15395425SUb9,ST1uL Q,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3. Permit Number:
•
Building Permit APi ation
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: ep'Coo-t—S1ni
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PROPOSED IMPROVEMENT LOCATIQN.
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Address: C-Leae-�
Property Tax ID #: — — Lot No. 1
Site Plan Name: S Block No. Zy
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof ':SI ZzPitch
Total Sq. Ft of Construction: I b Sq. Ft. of First Floor: f SOD
1
Cost of Construction: $ 754,20 .69 Utilities: —Sewer _Septic Building Height: too
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Addrss:
City:&l1( + L"o-' State: F1,
Company:
Address:
City: State:
Zip Code: Fax:
Phone No.7-77- ^-rF� l
Zip Code: Fax:/7?--'� -!�yZ
E -Mail:
Phone No 7 72— a
Fill in fee simple Title Holder on next page ( if different
E -Mail 10 &Lc a 0.
State or Cou ty License�e5?-
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is rquired.
If value of WVAC Is $7,500 or more, a RECORDED Notice of Commencement is require .
SUPPLEMENTAL CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TffLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 NOTR:E OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIYH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA!
FLORIDA /
�TOUNTY
COUNTY OF �T �
OF S_/
T W e -e_
The fo going mst n as acknowledge before me
The fo oing I str t w acknowledged before me
this day of. 20 by
this day of 20 by
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Name of person4naking statement.
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Name of perton making statement. 7MIN
I. O.�',.
Personally Known OR Produced Ident-
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Personally Known OR Produced Identifi ion "
Type of IdeppLL��fico ion
Produced YL I Ue I I S 11Cp.Yl$�
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Type of IdeAtificati;�n .i
Produced Ways S U w S �-
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(Signature of Notary/P Public- State of Florida )
(Signature of Notary Public- State of Florida I m .
Commission No. (Seal)`•.
to
Commission No. Sr (Seal)
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REVIEWS
FRONT
ZONING
IS R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19