HomeMy WebLinkAboutBuilding Permit Application I I
All APPLICABLE 1 ��F22O UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 00 L Permit Number:
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Building Permit Application Deg
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Planning and Development Services - . �, ,�qM@ ®��
Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMITTYPE:
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PROPQS; ' IMPROVEMENT LQCQTION
Address: 133 E Q o e 1 2, . . HS
Property
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Property Tax ID#: 5LIO 3 - 50 I-000Ib- o d o)- Lot Nol
Site Plan Name: 'I 33 CnW QOACT�jt e, Q Block No. _
Project Name: B vl
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DETA t DESCRIPTION OF WORK '
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CONSTRUCTION INFORMAl10N:
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 L 'L Pitch
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Total Sq. Ft of Construction: � � S� Sq. Ft.of First Floor:
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Cost of Construction:$ I �� `OD Utilities: —Sewer _Septic Building Height: Soo
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OWNER%LESSEE CONTRACTOR x
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Name cy)o�U CIO Name: I
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Address:_y 33 E W q .r ys RD Company: PA U I
City: Fe,+ T S+ Uuyk State: �Fb Address: -660 SW
Zip Code: 3t4 T2- Fax: City: Vejo Sta : '`-
Phone No. —1�2,—X32' 1{g Zip Code:�'j -9 6 Z Fax: (A
E-Mail: )\J�Ut1 -7S'16 Q yah D rj u. C &ten Phone No ZOS
Fill in fee simple Title Holder on next page(if different E-Mail L.v ke , )U
from the Owner listed above) State or County License h,r 1.!2 Z. 6
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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Sl1PPtEMENTAC CONSTRUCTION LIEN!,LAW INFORNiQTION
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 RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owne Less /Contractor as Agent for Owner Signature of Contract r/License H der
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L—v e j e COUNTY OF
The for oing instr en w s acknowledge before me The fo going instrume t w s acknowledge efore me
this�day of v� 20 by this day of 20by
L /Y) c,(c) 11 L� I�� Jit c(onr��11
Name of p n making statement. Name of person mak_ing statement.
Person y Kn wn OR Produced Identification Personal) own— —OR OR Produced Identification
Type o Identi ication Type of en ification
Produ ed JWARSHAW Produ ed
Notary Public-State o`%lorida
Commission=GG'87062
TYLER IWARSHAW
My Comm.Expires Feb 18,2022 Notary Public-State of Florida
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( gnatur f Notary - (Sire of tary `e. 41y Wx fires Feb18,2022
/ /" �7 0/� Bonded through National Notary Assn.
C ion o. ( U (Seal) Ci o (r3L�di
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OEIEWS FRONT ZONING SUPERVISOR P NS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW IEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.