HomeMy WebLinkAboutBuilding Permit Application � 1
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 I O c7(
0
RECEIVED
Building Permit Application
Planning and Development Services NOV. 2 5 2019
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Building and Code Regulation Division =ermitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 "* i Facie County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: ��d �� 106P110 LA171�r
Legal Description: PALM (`rt ou 61 1) `(°U4 t;- LvT If (p, 1a)1e) CD12 wm- xw)
Property Tax ID#: Spa 060- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
_ _�;;..,
P 4-A4 SWIz • N '• A'"�.'
CONSTRUCTION INFORM'ATION` r
Additional work to be performed under tispermit-check a appy:
HVAC Gas Tank F]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator I Roof a a Roof pitch
Total Sq. Ft of Construction: 3 SFt.of First Floor:
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Cost of Construction:$ >y,`7vl S Utilities: _Sewer E]Septic Building Height:17
OWNER/LESSEE + , OR
i:CONTRACT _ r
Name Ym � �( l`�LU(: t`1f Name:
Address: Company:L° IZfJrnAL a r�1Xr
City: EC91 O'TE6CL State:_EL Address:AC)/ a 5.
Zip Code: Fax: City: A&L 5r LLtzts State:�L
Phone No. 6/�- ��b- /'���o Zip Code: -3 Fax: -7 335-155Y
E-Mail: — Phone No. '77a- 3��GjSSz�
Fill in fee simple Title Holder on next page(if different E-Mail: 7T. Uuzs ie Gri9RDlTI RUUFu/I�, C'�SYn-
from the Owner listed above) tate or ounty License: (ACL 0,:507 S/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPL.E�MENTAL CONSTRUCTION LIEN LAIN INFORMATION„� ,F �` t � ,f x �”
61
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 thepermit 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing-woXk or recordiMyour Notice of Commencement.
nature of OwnT/Lessee/Contractor as A for Owner Signature of Contractor/Li&dse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF ;5T LIJ.0Z4-
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a� day of /V la>� ___,20/1 by this 9/ day of Py_-rL 20„d by
-L h0&85 SrJnr) ► hel_a= _:BrAp 15, Akk_ko _
Name of person making statemen Name of person making statement
Personally Known_�( OR Produced Identification Personally Known)—OR Produced Identification
Type of Identification Type of Identification
Produced Produced
zj/�— J 4 OLU
(Sign ,ure of Notary Public- ate of Florida) (SignatUre of Notary Public-Slate of Florida)
/bey p ,�3 7� o�pgY PU DENISE LEMAY o, Pbe� DENISE LEky
Commission No. (i a * gppIMISSION#GGO iFommission No. d�Z` �o * f*�ryMISSION# 77376
* EXPIRES;March 23, 1
m,9jFo t°`���eBWlded ThN Budget Notary
4- EXPIRES;March 1
�p�FOF F<�p Bonded Thm Budget Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17