HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INF MU IT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` Permit Number: I I �inn�
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial - Residential
PERMIT APPLICATION FOR:
P,ROP.Q5ED INIP ROVE MENT L'OCATI,QN
Address: WAG QR ►+�.tl� �j\V � �C.�r1 t`�jC C.�'1 l,. 1-3ZIq`J�
Legal Description: IJ,&M-t> Island Inc-, AQ0WM— SeC_-Vkon \1 Aa.LI_�O
PAJ1D ►J Co VA Mon E(.2.me Y)
Property Tax ID#: 44 - ' ®+ - �Z{ 3 - - �. Lot No-,
Site Plan Name: Block No. ,--
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
"CONSTRUCTIOM]N FORMATION
Additional work to be nertormed under this permit-check all apply:
;+ ❑HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
❑�
i 61�2,. i'. Electric Plumbing []Sprinklers ❑Generator �Roof � Roof pitch
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Total Sq. Ft of Construction: 3 Sq S In
of First Floor:
Cost of Construction:$ �j� Utilities: —Sewer❑Septic Building Height: 102-
ti; OWNER/LE CONTRACTOR•
Name tJ\G1n4\QS 1�.15C i YYO Name:
Address:_kQZ16 0-e_y yS company:TQTU_ T2CQ1;lNC-1 15�I'51CtVYVS
City: 'beac-VA State:t L Address:i3a QJ SE `100kki1JiC,A It\2
I Zip Code: 3ZIa5_- Fax: City: S-CV%gVT State: F-L
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Phone No. 50pj� Zip Code: QQ-+ Fax: _44..-gga4 033
I E-Mail: Phone No.'4_JQ-g_A--a-SO3r�
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Fill in fee simple Title Holder on next pagg(if different E-Mail: 'ZQ l 1N S*rn5 ne,
i" from the Owner listed above) State or ounty License: C.C-(- 3 $�
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SURPLEMEN;TALwCONSTRUCTION Ll•EN'.LAW INFORMATION:
DESIGNER/ENGINEER: Zc Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
'i Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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.
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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
i; structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
i 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
j 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 or_l;etording your Notice of Commence t.
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i Sign re of Owner/Lessee/Co g or Owner Sign a of Contract o icense er
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{; STATE OF FL STATE OF F
COUNTY O \� COUNTY �C \�
I° The org9ing/inst instrument was ack wledged before me The or ing instrument was acknowledged me
this =da o �,20� by this' ay o � w��.26 b
l Name of person making statement Name of person making statement
Personally Known )gZ�( OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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I' (Signature of Notary P -State of Florida) (Signature of Notary u ic-State of Florida)
'- Commission No. (Seal) Commission No. (Seal)
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#REVIEWS 0 ISOR PLANS VEGETATI AA*-^~l MM s5 �tROW'
PIVVpWnber 7 REVIEW REVIEW �.x11 CER � `
DATE
RECEIVED
j' DATE
j. COMPLETED
•, Rev. 8/2/17
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