HomeMy WebLinkAboutBuildling Permit Application ALL APPLICABLE I FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date:" 6 1 -I Permit Number: I CI 01+-- W lto
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COUNTY R APR 10 'L t
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Building Permit Application Per deep- cur.,
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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 APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION -
Address: 7 ►o I ±` . I. ' I . _
Legal D scription: _...._ �'� >t boS ` �� _� I.
Property YTax ID#: 16I -L07-0 DOC) -
9 Lot No. oZ:1
Site Plan Name: Block No. 3 a
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
a-nqui0 le,A,0 ot_cc:ythan Snu,l l. 3 sc-)t, j
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CONSTRUCTION.INFORMATION:
Additional work to bp_17rtormed under this permit-check all- apply:
El HVAC I 1 Gas Tank ❑Gas Piping Shutters I-1 Windows/Doors
0 Electric El Plumbing 0Sprinklers 0 Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
COM
Cost of Construction:$ p� •0 g, Utilities:Sewer Eli Septic Building Height:
OWNER/LESSEE: CONTRACTOR:,, : - .,
Name Sh-Y 'Nu. Name: 6 CV l 3X0 ., ,,,I
Address:?(g03 NOi-t-�h. 6IJC}V Company: LC U) S 1- ur r *€ j us
City: f1--c -€X €- State: Address: b BOY, 1 S I 'd 3
Zip Code:'3�5 l Fax: City: 0{rL ,t) State:
Phone No. .1789-(p ,3'' (Do'l.�(� Zip Code: 6�-r'S 7% Fax:
E-Mail: Phone No. Vou.3 - 1_]a- (-,'63 .
Fill in fee simple Title Holder on next page(if different E-Mail: 'OZ.S ld.P (Yt,�-fS (� w` •
from the Owner listed above) State or County License: Cc��1 , • 1 17
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
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,b.SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:_
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SiMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: __,_Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resu 'n your paying twice for
improvements toy. r •roperty. j fa otice of Commencement must be recorde an poste. • the jobsite
before the first ins,ect on. If •u in end to obtain financing,consu Ti'th len, r o an a •me before
commencing wor or r-cor•'ng you-Notice of Commencement.
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Signature of 0 net]Lessee/Contractor a Age$tt for Owner Signature of Con rctor/License HO der
STATE OF F ORIDA STATE OF FL• 'iDA
COUNTY 0 I Qrtl,r7 t,y COUNTY OF/ # c e '
•
The forgoing in ru ent was acknowledg before me The g oing'/stru ent wa cknowledged efore me
this da o ` `{ii(,. ,20 by this da of -MI-IT-4 ,20 by
Name of person making statement Name of person making statement
Personally Known •,C OR Produced(dent'` .tion Personally Known X OR Produced Identificati
Type of identification o. Type of Identification
Produced Produced
.._
( ignatureofN• aryPublic-Sta;eofFl. i- r. ;Signature of Nota •u•Ic-S. ,- . •r..
Pa Nota Public Stat rida u�'r°�e Notary Public State of F,I rid )
Commission +off „ec ry �5 �♦j Commissio i�gr �, aboni (seal)
Ka+�M Riccaboni
z M Commission FF 9$1647 y:_ • My Commission FF 9$1647
c o y• ' dd Expires 05!2$!2020
Pita” Expires 0512$12020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE i
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED i
DATE
COMPLETED
Rev.8/2/17