HomeMy WebLinkAboutBuilding Permit Application k
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ALL 'PPLICABLE INF9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f,.., i c.. .1,
Da e: Lk-571P, Permit Number: CAU 1 —0 I-:40.2. 0
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Building Permit Application
1 ' OVED
Plao ning and Developtoetit Services APR and
Build0 ing Code Regula'fion Division 5 2018
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230p Virginia Avenue,40q Piercg. i
'FL 34982 ermtting f.)
PhIne:(772)462-15531 Fax: (772)462-1578 Commercial V-- Residdrrtgartmenr
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PERMIT APPLICAIIION FOR: To Select from dropbox, click arrow at the end of line
,PROPOSED.IMPROVEMENT LOCATION- -
Address: -5 /50 I I i 4-“o p .k't (--cecfe r i?ci 5 Ca(e ,„, / C—
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Legal Description: 1 i
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Propirty Tax ID#: (oLC06_ 7 9- bC9
Lot No.
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Site Plan Name: 1 ' Block No.
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Project Name: 1
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Setb cks Front , Back: Right Side: Left Side:
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0-El 1,12tViDES-C, RIFFECINI:.aWORK:-,
A--f 0,1_,,,,, e I et:,--i— con,"e./5,.."— t..,vn.. ybc-4- 4.-• /- key-,,,-. I t...4-- 7..- n
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it40:010:40MOPORIVIAVON:::
'AdcApal work fobDeritOrMeil under this permit-check all laa;apply:
rf HVAC ‘as Tank Das Piping Shutters El Windows/Doors
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0 Electric Ellumbing Sprinklers [j Generator 121 Roof Roof pitch
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Total Sq.Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ 3 i:54.-5-- Utilities: Sewer El Septic Building Height:
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`:-ONE /LEE: - - - . - Y • . --- i?CONTRACTOR [- -. - 1-' • : ,11',-;:.:_l
Name ket;ewvi..,cii A < Pk2c :44 G Name:
Addre : 5'°/(03 .t A--'.A'.0:3 i245 h- -1. Company: - l-c- 4 . r 1 - J:4;
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City: , .e.- (..... ,t--ie
State: PX Address: 3-7$--6-- Obc-,,tch-c- 14—e-
ZiP Cide: 3 -3:IR- ' Fax: City: 1--7-N, Os.e er-e State:
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Phonl No. I ! Zip Code: 3 c4 i(8-c),- Fax:1461g-ille; '2
E-Ma I: I , Phone No. Lfro Lt- S1),-S.
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Fill in ee simple Title Holder on next page(If different
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E-Mail: CA-)61-Cr\--c_-'t r eortcdt‘:-A-‘,..-, 26e I t>c,--)14
from he Owner listed al bbi ve) 1 State or County License:QA-C k$'k 3 6, a- i
If valuof construction is$2500 or more,a RECORDED Notice of Commencement is required.
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'F'SPPLEMENTAL CONSTRU-CTION';LIEN:-LAW INFORMATION
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: I I Name:
Adidress: I I Address:
City: ! I State: City: State:
Ziii: P hone Zip: Phone:
FEnSIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Na e: i Name:
Address: I i Address:
City I I 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. Lu' ie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whit is in conflict with a'nyiapplicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
stru ure.Please consult With your Home Owners Association and review your deed for any restrictions which may apply.
In co sideration 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 permlit 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
WANING TO OWNER:Your.failure to Record a Notice of Commencement may result in your paying twice for
impr vements to your property.A Notice of Commencement must be recorded and posted on the jobsite
befo a the first inspet;ti;on. If you intend to obtain financing, consult with lender or an attorney before
commencing work orl,recording your Notice of Commencement.
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•'g ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLCO I NTY OF ORIDA 74 — / — :-e COUNTY OF STATE OF FLORIDA - / f—
The forgoing instrument wast acknowledged before me The forgoing instrum nt was acknowledged before me 1
this day of 4701' l / ,20 1 q by this.5 day/of ,0C . '' ,20 19 by
/0 art w •n n ��I • e,-,--1.e,-,--1. I./W ,-7
Name of person making statement Name of perso aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Typel of Identification I I Type of Identification
Produced Produced
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(Signature of Notary Pub!' S,Sot a Florida) MIKE MARTIN `griature of Notary Public-Sta'-• , i.,a MIKE MARTIN
..0 o= ItCt,a,'r�(,Public-State o1 Florida ......74.000% Nolary Public-State of 1 orlda
Commission No. I .,� ( C Rmmission No. - tai Commission#FF 21e951
!,� %iiitnlsslon FF 216951 I.
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",,-�..�-$ My Comm.Expires Apr 5,20'9 0 ?,f -4/ My Comm.Expires Apr- 2019
"'�Q i��o Bonded through National Notary Assn. I '''E O;;;°`� Bonded through National N0 Y Ass q
REVIEWS FRONT I ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
REC IVED i I
DATE
COMPLETED
Rev.8/ /17 jli