HomeMy WebLinkAboutBuilding Permit Application! , ,
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ALL APLICABLE INFO MOT Q
4 BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date. -5- 1 Permit Number: 1 C\ o4
,. -----72- 7-i:=',-- -;'• "i
COUNTY
1 Building Permit Application RECEIVED
Plan ing and DevelopmentjServices APR 0 5 2018
Buil.(ng and Code Regulation Division
23001 Virginia Avenue,Fort Pierce FL 34982 Permitting Department
Pho I e:(772)462-1553 Fax: (772)462-1578 Commercial Reside.i1ia1Ce County
PERMIT
IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line '
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PRO,c§j___ INI„ PROVEME�NTLO__CATIONA_^ .. ____:::1:,�._ ._- _ -----. ----- �` --�°
Addrss. r7_ e ' � �,
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Legal escription:
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Property Tax ID#: t34)I'' (er/5" 0079 -CSO — , Lot No.
Site P an Name: i ! Block No.
Proje Name:
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Setbacks Front I ' Back: Right Side: Left Side: j
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:D,ET. ILEDiDE� CRIPTION OF WORK: _
4 c\n vi.l> o,- a_ 4-cam-, I Lt See - e ",...s , r 1
kr- \.c.,ti-c.J� i.c!' C e',I i `- Cts yr z n S Y cAr� l`vGT
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C kfrgriCT ON INFORM4:TIO2 '-* Z _ 3_�._. ___ �" {
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Additional work to be a armed under this permit-check all pai apply: ,
IVAC 1 .Gas Tank ❑Gas Piping 1,I Shutters ❑Windows/Doors ; .•
DElectric DIPlumbing ❑Sprinklers • D Generator D Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft.of First Floor:
Cost of Construction:$ 111/60 Utilities: Sewer El Septic Building Height:
Et IEivLESSEE < 1.1. CONTRACTOR:. '
Nam ./a kew0d I i' (-le eI' 2�, lie- .0
Name: o c,., Com. .
) : .-, ,
Add ess:cam 9 673 '5' ',-',cV i (a� ' 54 Company: Gia -P-- A-c- (LI vxdi •i- .^
City: Cc:cs � e.'•�7 State: L Address:
Zip ,ode: 3.3 3.Z I Fax: City: _ (J• e ere State:
Pho i e No. I ' Zip Code: 3c./95---d- Fax: `c e,Lif- 1( .- -)
/ �� 9 -
' Phone No, f!L t(
E-Mail: �L- . � Jt+
Fill in fee simple Title Holder on next page(if different E-Mail: L.d O -c...,` r e i l‘:-V-1,vn62' " I Is c.-41
from the Owner listed above) State or County License:
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- l.5- 1 3 Co&
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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SUI F LEMENTAL CONSTRUCTION :LIEN LAW.I:NFORIVIAT.LON-,
DES}GNER/ENGINEER:j —
INot Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: I I Address: '
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City: 1 i State: City: State:
Zip:I Phone' Zip: Phone:
FEE IMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Na e: i ` Name:
Addtess: 1 I Address:
City: I City:
Zip: Phone: Zip: Phone:
OWNNNNNN�R/CONTRACTORiAFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi 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 an 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 perlmit 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
imprgqvements 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.
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Signal ss
ure of Owner/Leee/Contractor as Agent for Owner Signa e of Contractor/License Holder
STA E OF FLORIDA /' , STATE OF FLORIDA,/j
COUNTY OF 71,L . kt„r •-/ COUNTY OF 24 - ,A ` ^ I
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The f r ing instrument jwa acknowledged before me The forgoing instrumen was acIynowledged before me
this day of i wf� ,20(Ct by this,5 day of �`'. ( ,20I 9i by
liz.,:),„ I
,_,-, ,,
/6„,....._ , , ,
Name of personLaking statement Name of person making statement
Pers nally Known ►/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification 1 Type of Identification
Prod iced I I Produced
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(11.4.A4 / 1-2 -'— . — -- .- — -;=1—4
(Signlature of Nota •u(OMxe of Florid�IE MARTIN I (Signature of Notary Public-S +te p' Vd cla) MIKE iMARTIN I
29 --.1`�: Notary Public-State of Florida i ,4c ��; Notary Public-State of FI rlda
Commission No. SIN = Com E n#FF 216951 _ �� ommisslon#FF 2139'.1
y" Commission No. eag �
%,��- S:. My Comm.Expires Apr 5,2019 �.', o My Comm.Expires Apr 5, :•019
,�',,, ,,' Bonded through National Notary Assn. ''';roc F`` � Bonded through National Notan peso. i`
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RE IEWS FRONT ; ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 1 ; '
DATE
COMPLETED
Rev.8/2/17 1
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