HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi 11
All APPLICABLE INFO MUST BE COMPLE-(FD FOR APPLICATION TO BE ACCEPTED
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Date: 1 1`� � �.> � Permit Number: . � � 617"
MANNED'
Building Permit Application JAN 19 2018
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
PERMIT APPLICATION FOR:
Address:
t3 7,7& I
Legal Description
Property Tax ID #: �^' l>? �� Q �— O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under tnis permit— cneck all tnat apply:
_Mechanical Gas Tank —'Gas Piping _ Shutters _ Windows/Doors
_ Electric Olumbing _ Sprinklers _ Generator-,-....'- Roof Pitch
Total Sq. Ft of Construction: ; Sq. Ft. of First Floor-.,'-'
Cost of Construction: $ -� i� Utilities: _Sewer _Septic.. Building Height:
OWNS 7%
I CONTRACTOR:
.Name�?✓���/_i TTG /�fJCL/.q�✓Ai✓
Name: GUr~ntP47S
Address: Z4.4A /y, G.% _
Company:,,Ur %rr-+STib 1—(OA,55 r
Address: CDNT r V\AbeM Lys� -#',
City: F-5; L State: =.4
City: V-� e6<' kAA--, A CM State:
Zip Code: 314-2 � Fax:
Phone No.�O 6a
Zip Code: 3'340 1 Fax: V J
Phone No '9 S pia • �� �S�
E-Mail 611N.UrAr lif-i(n S 7,003 @ YAtAG0 COW\
E-Mail:
Fill in fee simple Title Holder on next page ( if different'
from the Owner listed above)
State or County License `Fuor`�Owk
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU�TIC}N LIEN 1 !FQRM TIDN:
DESIGNER/ENGINEER: I Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name`.
Address:
Address: I
City: I State:
Zip: Phone I
I
City: - State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _INot Applicable
Name:
Address: I
City: I
Zip: Phone: I
I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Ai
I certify that no work or installation has con
St. Lucie County makes no representation th
which is in conflict with any applicable Hom(
structure. Please consult with your Home O%
In consideration of the granting of this requt
in accordance with the approved plans, the I
Aication is hereby made to obtain a permit to do the work and installation as indicated.
nenced prior to the issuance of a permit.
t is granting a permit will -authorize the permit holder to build the subject structure
Owners Association rules;: bylaws or and covenants that may restrict or prohibit such
ners Association and review your deed for any restrictions which -may apply.
>ted permif,ll do' hereby agree that I will, -in ail respects, perform the work
,orida Building Codes and St. Lucie County Amendments.
The following building permit applications arq 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
improvements to your property. A Nc
before the first inspection. If you inte
commencing work or recording your I
tecord a Notice of Commencement may result in your paying twice for
ice of Commencement must be recorded and poste n the jobsite
d to obtain financing, consult with lende ran rney before
otice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa e o C n racto License er
STATE OF FLORI ft / ,
COUNTY OF /�
TATE OF FLORIDA
COUNTY OF
The foArgo'ng instrument was acknowledged before me
this /a eay of 2011 by
The f r `09 instr ent was acknowledged before me
this day of QF by
C/k�q�)Vokalv
AvOtAe-
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(Name p rson acknowledging I
(Name of person acknow ledu d
sVArPya I DARCI E. IVEY
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Notar Public -State
Y Flor
r°.. Notary Public - State of
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lorida -
?N; ; v? Commission # GG 01070
•- Commission # GG O10
07
(Signature of otary Public- t t�; daMY Comm. Expires Aug 2
, 2(� re of No ary ublic- tat„j� ; Cori °mm xpires Aug 25, 2
\ Bond,,d through National Nola
y Assn. n ed through National Notary A,
Personally Known OR Produce I en ification
Personally Known OR Produced Identificatio
Type of Identificatio
Type of Identific
Produced L
Produced Vo
Commission No.6��0:7+Q'? (Seal)
Commission No. -Ol0%(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
I REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
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