HomeMy WebLinkAbout Building Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED11 '
Date: 1'3 Z�Z� I Permit Number: "a -
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Building Permit Application
Planning and Development Services
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Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax- (772)462-1578 CBDG Funding
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PERMIT APPLICATIONFOR: AlgQ SFV
PROPOSED IMPROVEM'ENT-LOCATION
Address: -r. 133.D. 6Ph, oP1 DYZ-. rr. P1Bar.6, ( p..�e„�� R, rz SSmfss
Property Tax ID#: 3gOZ,l- COB - 03Y 1 000/1 Lot No. 3 9
Site Plan Name: I Block No. Y9
Project Name: D&Nca
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DETAILED DESCRIPTION'OF WORK
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Atgi-i c_63 HoofF ; 3 guo� 2 13.0-rO clot IC1»e,0oL7e
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New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTION INFORMATION ;a
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Additional work to be performed under this permit-check all that apply:
mechanical _GIs Tank —Gas Piping _Shutters _Windows/Doors _Pond
vE(ectric dsPlumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Z 22 Sq. Ft.of First Floor:
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Cost of Construction:$ 55' '7Sy , (t/-) Utilities: _Sewer V-11'Septic Building Height:
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OWNER/LESSE.E CONTRACTOR: _
Name 1k1c1J4bt, JPrVtLSi Name: 61&5_6 0L.P,0td3J516l, TZD"t•
Address: 5 0Y 6-OUPr7 D►- Company: GIL-11106 �"�-vw�r►� °�4_,' 1,✓.c
City: fir. P1ori-`b State: Address:
Zip Code: 3g99 7,. Fax: city: s State: rn L
Phone No. 772-® J 79- 7S-01 E- Zip Code: 3q 9 6 o Fax:
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Mail: 2G&FA-O'Q°c-00 3(2YO►400.cO,$A Phone No '7 33 41-?tq a
Fill in fee simple Title Holder on next page(if different E-Mail Grege-,0- Ge-zN0s1CL. COO,
from the Owner listed above) State or County License eCzC / So�l 27
23751
If'value of construction is 2500ior more,a RECORDED Notice of Commencement is required.
If,value of HAVC is$7,500 or mlore,a RECORDED Notice of Commencement is required.
NSTUCTOILAWNSUFPLVENTALC RMON w .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
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Name: Name: noLDIJA-rc-4- 1?A-.nc., N.�.
Address: Ra(o DULA%,J)6YLA Aw Address: Z5 7zs_ C,0MGt 1?,0JC _ 12p, 41 1)00
City: IrT. P+bh-� i State: r City: State: P Z
Zip: 349�r o Phone 1 -/-72- yBo-77S l Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: a,'Not Applicable
Name: Name:
',Address: Address:
City: I 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 cgertify that no work or installation has commenced prior to the issuance of a permit.
St9 Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In'consideration of the grantinglof this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approveLl.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,
acicessory 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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.
Wnatule of Contractor-or-Owner Builder as applicable
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STATE OF FLORIDA
COUNTY OF Sr• ty c.)tii
Sworn tq(or affirmed)and subscribed before me of e✓ Physical Presence or Online Notarization
this�day of Sp NV-n.Y -_20 Z3,by
Name of person making statement.
,Personally Known ylst OR Produced Identification
Type of Identification Produced
(Signature of Public-State of Florida)
VVIVYWIr
Commission No. I eal) pigdir
Am .Swu
el iMy"ID as 12437e
REVIEWS FRONT ! ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21