HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPI
Date:
SGAW
blINIFA
Building
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
TO BE ACy
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Permit Number: 6 v-7q7
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Application
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Commercial , Residential ,
PERMIT APPLICATION FOR: To Select from d�opbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: I Kf e,:4 p I' L 5 LI L�9
Legal Description: 60fl L)"V c� Z - T-zIa,4- Z l a' ��= �69
Property Tax ID #: f y �1 0-2- — 005 1
Site Plan Name:7l.Ps
Project Name: &,'L A-vJCi-1
�tbacks Front Back: Right
Left Side:
Lot No. a Block No. 214
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to e nerformed under this permit - c eck all that apply:
❑HVAC Gas Tank ❑Gas Piping _ Shutters P91Windows/Doors
CQElectric Plumbing Sprinklers Generator a Roof Roof pitch
Total Sq. Ft of Construction: S of First Floor:
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Cost of Construction: $ SS 60() Uti ities:Ft. Sewer[] Septic Building Height:
OWNER/LESS E:
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CONTRACTOR:
Name - T rim /3 ,0" rJL
I
Name: /_-1a .��— ,& S " l i
Company: 51 - .,1 t S
Address: I/ L� .,ee-� , �,-(' 6L
City: ��� .GState:
Address: ,,eL',-.- G� `
City: ram% �ie-�G State: r Y-
Zip Code: 3 c/9 L/S Fax: a/ �%
Phone No. 7 -.5 2- - F I C-
Zip Code: 3 t/y Y7 Fax:
E-Mail: rivn J, ✓/ L co
Phone No. 70 - -- I "1
Fill in fee simple'We Holder on next page (if different
E-Mail: S kq P I e,,ed, a- Ar"'
from the Owner listed above)
State or County L' 05se: CM 1 -3 2_-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA\'
INFORMATION:
DESIGNER/ENGINEER:
Name: "7-VrN 1 Tc zTneviC
_ Not Applicable
--3' ArC �
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address: A o r, -7 L L A t y Ai6e - V I
City:
Zip: ; q ,96® Phone
Stater
— 77 1
I
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
I
Name:
Address:
Address: I
City:
city:
Zip: Phone:
Zip: Phone: I
I
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.
The following building permit applications are exempt from
accessory structures, swimming pools, fences, walls, signs,
WARNING TO OWNER: Your failure to Record a Noi
improvements to your property. A Notice of Coml
before the first inspection. If you intend to obtain
commencing work or recording vour Notice of Coi
Signature of Own
ras Agent for
STATE OF FLORIDA
COUNTYOF i vim.
The forgoing instrument was acknowledged before me
this Y—'3 day of 20 ;T by
Name of person making statement
Personally Known OR Produced Identification
Type of Iden 'fi ation
Produced ,r%/�`�� CX" f.e
(Signature of Notary Public- State of Florida )
Commission No. c_2 (Seal)
RE'
DA1
REC
E;SPLB
FRONT JEFF
EG
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='StMinorlda
y
CommIssic
i # FF 932680
V OFFS
•' My Comm. E
Ires Nov 3, 201
COMPLETED
Rev. 8/2/17
lergoing a full concurrency review: room additions,
an rooms and accessory uses to another non-residential use
of Commencement may result in your paying twice for
icement must be recorded and posted on the jobsite
ancing, consult with lend or an attorney before
iencement. J
Holder
STATE OF ORI A
COUNTY F
The forgoing instrument was acknowledge db
'efore me
this . ay of _ C► �( 20 1 by
\Sav, C k Sm
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced 1' %, -b t
(Signature of Notary Pu8t11c S,c,�cdi
AARIE GIVENS
Commissi SIrJN#GG(�p)
= 2020
EXPIRES:Uecember �r�derwriters
Bonded Thru Wary Pub"r
REVIEWUPERVISOIR I REVINS I VEGETATION
I S REV EWLE I M REVIEW
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