HomeMy WebLinkAboutBuilding Permit Application w�.ei. nNu M1' nY•t ....tK�
APPLICATION, BE ACCEPTED
All APPLICABLE INFO,.MUST BECOMPLETED'FOR
Date: Permit Number:
j
RECEIVEb
2 2019-
. .
ildin mit App'lic5
u Per a �Qcie coon
tY, Permuting
Planning and Development Services
Building and Code,"Regulation;Divisioii
r12, -�?t`•t.: t,t', -1r. �
F 2300 Virginia Avenue,Foil Pierce FL 34982
Phone, (772>.)462- ,553_-Fax:(772)"462-1578 COmme►'Ci,al � - Residential,
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P.E�RMIT�APPLhCATION F,OR _� :�.;� .� �._ - -• t :.:,, h ,,:• �,s" - _ t. •. .. . .� ss;., . ._. . _
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Legal_pscniption .t ,130 " ro C�� -d\fid
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Property Tax ID#: Lot No.
Sit`e'Plan Block No.
Project Name
s Sexbacks Front Back: Right Side; x Left Side.
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itiona :wor to: epe orme ;un, er t:is>permrt;
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Mechanical j .: _`.}==-f:GasTank` ;< :Ga-s'.Piping, " u-"-h Shutters.,.,. Windows/Doors
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aElectric ,,-_,Plumbing: > Sprinklers;, Generator Roof, j. �; ,,;Pitch
.."s� ,_ �t.::{• 'S!t `._ ,'� T ?;- Sr-, + , t-,iT e je t;, :7 s .. ?. .R .a t-'.r ay ?'' .
Total'Sq:Ft'of Construction s. Sq.:Ft.�W First Floor:'
+SCnstrctCot Utilir,ye.,.t s_ :repi tic Building Height
Naive S v e d�!e Name:
Add"res ; owz-� Com any
State; Address
Zip"Coder � _� Fax. City State
x _.: _
Phone No.: a Y l` - 7 Zip.Code. -
E-Mail Phone-No
i
Fill'! simple Tale Holder-on next page(if different 3 .E=Mail S za"'
'tr �, }r � c
from the Owner listed above) r, ' State or County Icense
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- "� xF •„x.t'� } P ^i e+4 � 4't•S•. � : �j.,bA r a ,�, ',. k< � �¢ +, �£ � � y's �` S k
$!"- tn,rs,t r ,i,t4'". -v-"i.;�..a_,�.�y,w 5.x.1`.. •�i'Ti�. + .�S�.+s i_x :�''�>� +rr, ,'a,. f�.< ;i7r �,., f � 4..- Y £, -
If vai6e".", consir.0 on.i5 2500.or more,-a RECORDED."Notke of:Gommencementi is re wired.
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DESIGNER/ENGINEER.- -Not Applicable MORTGAGE
COMPANY Not Applicable-
Narill ZF Name:
Address:- --- --- Address
. .....State: City:,
State:..-.
Phone - i Zip: Phone-- .
Ip
FEE.SIMPLE-T-ITLE-HOLDER: BONDING-COMPANY: ----Not.Applicable
Name. Name
- ress:a --. �Address: 7
City: City
-
Zip Phone
Z
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.:OWNER/CONTRACTOR AFFIDVIT:,-Applicationis hereby made to obtain l perni do the work and installation as indicated.
I
boVotik or has'commenceprior'cert d td-the issuaa per.
-'f- build tK6-s-Ubjeftitructure
St.:'LU'c'i*e"C,o"un't'y,'m"aki2�566�'-tepresentation,that is granting a permIt,wiII!adthorii6Ah e",e'rmit holder 6
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which is in conflict with.any applicable Home Owners.Association rules,bylaws or-an covenants that.may restrict'or prohibit such
t deed oj 'a
structiJre�.plpase consult with ypur,Hollllers.Associa ion.and review your eo,,f, ny.restrictioll ich 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 acc6rdarl with the approved jjlarl Florida Buj1,dihg-,jZpd6sand St..1_6cie'Coun
tyAmendments.
.;The following building permit;applicatons areexempt from undergoing a full concurrency.review.room additions, ;
1 accessory struetuxes,swimmin ools fences,walls„si ns,screen rooms and accesso uses to another non resldentlahuse
improvernents to your-property: A Notice:of Commencement must be'recorded-and posted on'the-jobsite.�..-
beforethe first inspection.1f you intend to obtainfinancing, consultwith'lender or an attorney e
ommencihg3mqK6rrdcordi-rf9 yoUrNoti-til-CorhMOncement.,
f
Signature o Owner/;Lessee/Contractor es
'Ageov or,,Owrl
bintir'd d- WQc`e r
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STATE.. F.FLORIDA
S OF FLOP
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COON 6,:-'�� ,, '6)1,. . .
N F C 3 NTY OF The ristrumprit as-acknowledged-before-me. Jheforgoing instrumen was.ack.npwledged before
-me
-`hlforgoing
i day of
8 of k—
t s- 6� 20_1A by this 2
(Narill
qq,icknowledgirl (Name of person--acknbwle'dgingz)
(Signature of Notary,P Uc:State of Plorida) 't k (Signature 6; +7”
Personally Known "0 Produced Ident'ification
Personally Known OR Produced Identification
-Type.-of Identification.- Type of Identifica
Prpqyced Aw, Produced EANNA MARIE GIVENS
P
,�.*,oMYc0MmI53r0N#GG022023
Lberl 2020
PIRES:Decemq
ornrl No, mission Till Notary P0A1darWft)ir
GIVENS M
DEANNA MARIE Co
W
C No
)23
20
Nly COMMISSION#GG 022
publlc un� -tar
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Bonc a MANGROVE
E, VEGETATION SEATURTLE
I 1-1
REVIEW REVIEW REVIEW
REVIEW REVIEW
DATU'��`
RECEIVED
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COUNT
DATE
_COMPLETED,
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