HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST'BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date:_' 1 �LO:1,6 Permit Number: `a o C i'
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Building Permit Application
Planning and Development Services `�``�r
Building and Code Regulation Division Co0goo
2300 Virginia Avenue,Fort Pierce FL 34982 06y` ,
Phone:(772)462-3553 Fax:(772)462-1578 Commercial Residential"•
PERMIT APPLICATION FOR:--A?,00 j
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Ni ' t Address: c?Ub9 ea
Legal Description: t
Property Tax ID#: i� a- ` `y am - 00c)-I . Lot No. 1 "1
Site Plan Name: ,, .A��(e�` �i1�'� Block No.
Project Name "Ox-44,r. it
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Setbacks Front Back: Right Side: Left Side: iI
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Itlona_ wor to e e orme un er t is permit—c ec a I I appy:
L=MVAC Gas Tank ❑Gas Piping _Shutters FJ Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: q`i le S . Ft of First Floor:
Cost of Construction:$ `73 4 O 0 Utilities_LjSewer aSeptic Building Height: S ►r
"a,"✓L:: rY}•� ';fin:'� S5i',�:r *.: -`xYY'.� 'i}4.:..0 i J: :iy
^ >'aj,�. INNER' �.r y�i`x.�..rT,'�`��b.'�,`•''". + t. �,+°lt;cqr �X-s
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Name Name:' l?11r� -tl.C� � ,,n �;;r�
Address:- hyr_L+b Company-miKUk
City: Z >i Lr p.� State Address:
zip Code:__�:H 914 L Fax: City;�1Q,�S2�r1 �j,�Q C.Q-� state:'
Phone No.T1.'a- ale 1,p�iR.trp Zip Code:S-4_A�t Zn Fax-1� "SII
E=Malt: "' i Phone No. 1")�.- A3 - In
Fill in fee simple Title Holder on next page-Of different E-Mail: f �)
from the Owner listed above) State or County License:
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If value of construction is$2SOO or more,a RECORDED Notice of Commencement is required.
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.�-�+`�. f't"$a,
DESIGNER/ENGINEER:^ ' _)k_Nat Applicable MORTGAGE COMPANY: Not'Applicable
Name: Name: f�
Address: Address:
City: State: City: State: ii
Zip: Phone Zip: Phone: !i
FEE SIMPLE TITLE HOLDER: k Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address Address: {I
City: City: I
Zip: Phone: Zip: Phone: I
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',
-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 inspectio u intend to obtain financing,consult with.lender or an attorney before j
commenc!nR work or re ordin o
jrJN otice of Commencement.
Sign re of o er ntractor as ent or owner sigddture of Contractor/License Holder
{ STATE OF FLORIDA STATE OF FLORIDA _�/
COUNTY OF ' fl? COUNTY OF__ axA'..
this day of_- /A&- ,2,g b this ALL• 2ocWby
The fPygoing rostrum t.was acknowledged before da re me The fo oin yof instrument was acknowledged before.me
,r iS f�r! ZC gA2
Name of person making statement' . Name of pe on making statement
Personally Known k_ OR Produced identification Personally,Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Pu l f 4Kenny {Mignature.of N
ommleelon GG 296697 Nary P
Commission No. a 1 Ot2o23 ' Notary teofFioIrs
Commission No. Sandramy y
lir ' xpidna oil (2023 2966lI7
REVIEWS FRONT : ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE, MANGROVE
COUNTER REViEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE �I
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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