HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: Ilan, y-� ��. GDFl n(ait Number:
i Building Permit Application S�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.IMPROVEMENT LOCATION
Address: l.srr 5;, �, WA1190nl6 L AiJ 1 5-MA,�, UJaL/
Legal Description: G D, a —1 ��
O 11 W — S7
8
Property Tax ID#: �lam' 3� v 803 - Oct Z - CP 00Z s Lot No. $
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Site Plan Name: W.41ti'��vn1C S"vU-T9 Block No.
Project Name: 99MA"'TA "UP9WG5;
� 1
(Setbacks Front 10J t Back: O. � Right Side: .1 Left Side: 6. 1
DETAILED DESCRIPTION-OF WORK: "
f9p Posr p vN&a- - fiW 1`lY
:CONSTRUCTION INFORMATION:,, .
rtiona wor to e e orme under t ispermit-c ec a appy:
®HVAC be
®Gas Piping _Shutters aWindows/Doors
Electric IN PlumbingSprinklers I Generator ® Roof �J IZ Roof pitch
Total Sq. Ft of Construction: 6.,137 S . Ft.of First Floor:
1 4
Cost of Construction:$ $��, 00® Utilities: X Sewer 0 Septic Building Heig t:�� O
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OWNER/LESSEE CO TRACTOR:
Name -
Address: (044-7 Company: A412P45 E ymfs, s" 644 f 4Al
City: EJrrDNLA'G State:III Address: P�D 9 SKI A,4e g154J ~I,L
Zip Code: ZVOS4- Fax: City: &)t-r S1_ "V-1 E_ StaterL.
Phone No. I-1�fpli p I - 73 1 q Zip Code: 34Q-93 Fax:
E-Mail:_s{1dt,N pilA�'�kgefa. a DD. Phone No. (--772— 828 ' 07,86
Fill in fee simple Title Holder on next page(if different E-Mail: 4 Co .'te.:b
.from the Owner listed above) State or Coun Yice CGG 160 8
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I If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ENGINEER: _Not Applicable Pp MORTGAGE COMPANY: �( Not Applicable
Name: I i OX- Name:
Address: S'. L, Address:
City: State:_� City: State:
Zip:R401 Phone: G - t9 Zip: Phone:
FEE SIMPLE TITLE HOLDER: )C Not Applicable BONDING COMPANY: Not Applicable
Name:�SA?t1 A4 �1/N Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
iln 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 work qffecording your Notice of Commencement.
C Z�1�2e� 0, /'_K11r4Ck ' ]IUR s
Signature of Owner/Lessee/Contract as A ent for Owner ignatu a of 0
ntra r i se older
COUNTY OF ST TE OF FLORIDA C UNTY OF STATE OF FLORIDA
The f�oIr oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this r day of 2017 by this�day of 20 �by
'Pr. da b. C04A40�A'
(Name of erson acknowled ing) (Name of r on acknowledging)
lq_ 9�_4 0�
(Signa-tLfe of Notary Public-State of Florida) (Signatu t
of Notary Public-State of Florida)
Personally Known _OR Produced Identification Personally Known�_OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Dw .- «. eA mo Commission No.
MY CiDiilSSION N FF 067057 ,• �y�...,, a.CELF UM0
EXPIRES:December 11,2017 = ` MY COMMISSION N FF 067057
Bonded T1uu NotaiY Pudic UMINWOM 2011
Revised 07/15/2014 Bo aedThmNot yPublic Unde�ers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW PEVIEW REVIEW REVIEW REVIEW REVIEW
DATE �,�
COMPLETE
INITIALS
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