HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� 3 b�
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Date: II / a07 Permit Number.
ECED E
Building Permit Application
Planning and Development Services SEP 2 j. 2017
Building and Code Regulation Division pERN,�GNU
2300 Virginia Avenue, Fort Pierce FL 34982 St. L c
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Reside,,tial c°`-`rtY, FL
PERMIT APPLICATION FOR:
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_ 1 3 Address: � lv or USA j(x -�L , -( z
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Legal Description: Le �' S . 10Ge q 9 `ve' e"ti ✓►., '� ucCm eel� - _ -o �h e 14 )t-
Property Tax lD#: ��� `a 2;0 I ;� Lot No. .
Site Plan Name: �" T 1^ h Block No.
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Project Name: G� i
Setbacks Front Back: Right Side: �' 1 Left Side:S )
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DEVILED DESCRIPTIONFWORK
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CONSTRUCTOI( YRINFORMATION
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Additional work to be performed under this permit—check all that app y: {
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: ( Sq. Ft.of First Floor:
Cost of Construction: $ aB� Utilities: _Sewer _Septic Biuilding Height:
kOWxNER/ ESS� ° : � � _ rCONTRA`CTO,R:
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Name J� l .Gt�,q, 'Name: t.r D a �Y
Add _s,.). } �� /��ttl�c.a t G•ress �Compagy.. ut f,`, 'I /� t/�jC,4 .
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.Cit State: `, Address a C .r y__ ��� Ao S
Zip Code: .3 4 Q"93 Fax: City:` ,�5. State:PL
Phone No. 0 a Zip Code: Fax: -
E-Mail: Phone No O G
Fill in fee simple Title Holder on next page (if different E-Mail r`GeV d P4-h. - p '-
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from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEI\/I'ENTAL C®NSTR4tJCTl®N LIEN LAW INF®RMyATI If
_ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: SG�,r" ►'3 e! M t e'z PC Name:
Address:N Vkk -) G-f-y-clit Address:
City: State:,..�F City: State:
Zip: �,� C7 Phone ���. 7 $ I J�J 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 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
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
r The following building permit applications are exempt from undergoing a full concurrency review:room additions,
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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 or recording our Notice of Commencement.
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Signature of OWnerl Lessee/Contractor as Agent or Owner Sign atur Cont or/Lice er
STATE OF FLORIDA / STATE OF FLORIDA� n
-' COUNTY OF � COUNTY OF
The or oing instrumt Vas acknowledged before me The forgoing instrurpent was acknowledged before me
thi y of 20 by this 4 day of NLQerAb?r zoo by
Ah o_&,�S JA- Intley
(Name of person knowledging) (Name of(pArson acknowledgin )
%` �q�
ign � nat
(S r of Notary Public-State of Florida) (Sig ,re of Not y Pu lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ' ` � n Type of Identlfj'pati n
Produced 1. �tutr VivienneAFinle roduced Vim- �— ov
NOTARY PUBU
NOTARY PUBu ET V T3Q5STATE OF FLOR D
Commission No. STATE OF FLO IfiQmmission`No. Cam FF921
s Comm#GG1330 1 1 Eires 9123120 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 10
DATE
COMPLETED
ev. /2014