HomeMy WebLinkAboutBuilding permit application1LL APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Ifl o Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce Ft 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: UVIL i I
Legal Description: LLtlEt0000L PaV- - ( l( - 5 - 1511< 53
Property Tax ID#: 13ol- bps- 0300— oop- 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
)ETAILED DESCRIPTION OF WORK:
tux Lila" mow( mw Lonx a.6 -ion J Res,&Gi2 sflif-
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sq,5f o (LIO 5 kw iaeat
CONSTRUCTION INFORMATION:-
CONTRACTOR:
Name,Tai`Db z bawdda, MO -lin
rtl a workto e e orme under
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appy:
_V1_
Address:510�rTU(YII((ClLrPF,6i
City: (br-i—i Refs& State:
Zip Code: 3 4q 5 ll Fax:'7i;' Ll(F -373-7
Phone No. -M- q41-414-1
HVAC Gas Tank
❑Gas
Piping
State orCoffunty License: Com` I$1731 r�
_
Shutters
Windows/Doors
11 Electric Plumbing
QSprinklers
11 Generator
0 Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 3k5a. DO
Utilities:Sewer
El
Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name,Tai`Db z bawdda, MO -lin
Name:
Address: N - utbism
Company: Air LU1f17II�'jkyfgla HpGllt�
City:FO/� ri(�CQ. State._
Zip Code: 3y451 Fax:
Phone No.1 . `ru LI -7
_V1_
Address:510�rTU(YII((ClLrPF,6i
City: (br-i—i Refs& State:
Zip Code: 3 4q 5 ll Fax:'7i;' Ll(F -373-7
Phone No. -M- q41-414-1
E -Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail:P_Q +af`I vAkw. ot) n
State orCoffunty License: Com` I$1731 r�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
su���;€�n€t�Af_ L'AlYS7itUC'ilC3�i u€n� law tMFOR(v4ATlf)F!:
Signature at Dourer{ Lessee%Contradw Agent for weer
Signature of Coniractar/Li
DESRGNER/ENGRMEER: Not Applicable
Name:
MORTGAGE COMPANY. _Not Applicable
Name:
STATE OF FLORIDA
Address:
Address:
The forgoing instrument was acknowledged before me
City: State:
City: State:
this ,Z;4dayof llALt,YLh
Name-
Zip: Phone
Zip: Phone:
F & Iv�
Address:
FEE SIMPLE 7177.E HOLDER. _Not Applicable
BONDING COMPANY.
Personalty Known OR Produced identification
City:
OR Produced identification
Zip: Phone:
Type of identification
Zip: Phone:
Produced
Produced
{Signature of Notary P State of Florida)
f
(Signature of Notary Publ"
- tate of Florida )
Commission No. {Seal)
.Commission No.
OWNER/ CDNTRACrOR AFFRDVIT. Application is hereby made to obtain a permit to do the work and installation as Indicated_
f certify that no work or installation has commenced prior to the issuance of a permit.
St. Lurie County makes no representation that is granting a permit will authorize the permit holder to built 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 vatic your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, l do hereby agree that l 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, wags, signs, screen rooms and accessory uses to another non-residential use
WARMING TO OWNER. Your failure to Record a notice of Commencement may result in your paying turice 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 fender or an attorney before
commencingwork or recordingour Notice of Commencement.
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Signature at Dourer{ Lessee%Contradw Agent for weer
Signature of Coniractar/Li
a Holder
STATE OF FLORIDA G
STATE OF FLORIDA
COUNTY OF J�-
COUNTY flF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
Name:
this ,Z;4dayof llALt,YLh
Name-
_Not Applicable
Address_
F & Iv�
Address:
Name of peno
City:
Personalty Known OR Produced identification
City:
OR Produced identification
Zip: Phone:
Type of identification
Zip: Phone:
Produced
Signature at Dourer{ Lessee%Contradw Agent for weer
Signature of Coniractar/Li
a Holder
STATE OF FLORIDA G
STATE OF FLORIDA
COUNTY OF J�-
COUNTY flF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this J2Xdayof AGWl,{n ,2(310 by
this ,Z;4dayof llALt,YLh
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(�tichae► F. �v1�
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Name of person along tement
Name of peno
_
along stat ment
Personalty Known OR Produced identification
Personally Known
OR Produced identification
Type of Identification
Type of identification
Produced
Produced
{Signature of Notary P State of Florida)
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(Signature of Notary Publ"
- tate of Florida )
Commission No. {Seal)
.Commission No.
a�,x •�•,-- CHRISTI E J. CONWELL
Notary Public - State of Florida
CHRISTINE J. CONWELL
Com '
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