HomeMy WebLinkAboutBuilding Permit Application _
I AU.APPLICABLE I1 FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' I( 19
Permit Number: d A 961- , 0 Lei
IMAR 1 1 2018
Building Permit Application
• Planning and Development Services Permitting ORpOrtrnent
• St Lucle County
Building and code Regulation Division
• 2300 Virginia Avenue,Fort Pierce FL 34982
Phone7..(772)462-1553 Fax:(772)462-1578 Commercial
Residential
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PERMIT APPLICATION FOR: To Select•from dropbox, click arrow at the end of line
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' Address: 1313t1... ,ArcAi to., hio.,.. coft- Vitcce. .rt, stlq5(
[ Legal DeSCriptiOn;_ l,111(51.(1 1ttia5 -.i-dtirivatit,
Property Tax ID#: LID cv- 5c)0-- 03 i5300 I R Lot No.
Site Plan Name: Block Na. 1
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Project Name:
Setbacks Front - Back: Right Side: Left Side:
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Additi• al work to bp_Eirformed under this permit-check all ha/apply:
HVAC 1 j Gas Tank DGas Piping LJ_Shutters riwindowsipoors
0 Electric 0 Plumbing [I]Sprinklers 111 Generator 11 Roof , Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 51.e00. 60 Utilities: 1Sewer Ell Septic Building Height:
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Name CU W ti Cs-et-• Name:
1.,(A 6to °Lift - •
Addre,: i 4;31 X, 3 ,ANN., .- Company: bOlte. ,"r arl
. .
. „ . -h i .•State: F(..., • Address: 5 Ac -Tufykote ..t., i rxp.
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Zip Code: 3114 St Fax: - Pik- City:fort kirce- State: ft" I ,
Phone NoS i 5-378- 5218 • Zip Code: 3045_1. Fax:11,1--14(i19-.31. 1•
E-Mail: Phone No."1-1 -- ftt.-4{4-I
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Fill in fee simple Title Holder on next page(if different E-Mail: )okitea.a.ttioLita.ottres
1- from the Owner listed above) • State or Colinty License: cfpvaN 1'7 I gc...9 •
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEME TAL IONS -RU -l0 LIEN'LAW iN O6 TION w x
QESIGNER/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: . I
Zip: Phone: Zip: Phone: I
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. 1-tome Owners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit I do herebyagree that t 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
commencing work or recording your Notice of Commencement
/7Z: # 8 f .
Signature of Ourner/Lessee/Corittactor Owner Signature of Contractor/License Eder
STATE OF FLORIDA , i •
{,n• COUNTYSTATE OF O FLORIDA c '
COUNTY OF Weiut•LU.ei ,
The forgoing instrumerlt was acknowledged before me The forgoing iinstrumen was acknowledged before me
this44,day of° ;20 l j by this L D-day of f� ,20_8_ by
tittkatag 1% Bole. ikkaej e Bok..
Name of person aking statement Name of perso along stement
Personally Known OR Produced Identification Personally Known VOR Produced Identification
Type of Identification Type of identification
Produced Produced_
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1*It • . 61tiAIZZe.-.
etif,
i, 477.w,e.e(___,
(Signature of Notary P iic-State of Florida) ( i ature of Notary P is State of Florida)
Commission No. (Seal) Commisss• ,,,,,,y GHH151lNE J.CO ELL
�.....(iy,o,„, CHRISTINE J..CONWELL , f+�at`'�s Notary Public-State of Florida }
• --- . •`� Commission#GG 017839
t� •' issfo 3 108- , =. '+���'My Com.Expires Aug 21,2020 i
IOB Inde(talwiii 6t tary- A€\lGROVE
REVIE. „ v $�j• -um.Ex. rt l IbUPERtltSOR PLANS V.`
202 ` REVIEW REVIEW IEw
FI"`C ... ugh , . y Assn.
DATE . ,r _ I
RECEIVED .
DATE
COMPLETED
Rev.8/2/17
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