HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCA13LE INFO MUST BE COMPLETED FOR APPLICAliON TO BE ACCEPTED
Date: 4. �T Permit Numb
NNED
EWNWIROWnit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 1y'
Phone: (772) 462-1553 Fax: (772) 462-i578Commercial F
PERMIT APPLICATION FOR: To SE
PROPOSED IMPROVEMENT LOCAL
Address: _I_. 7 Jvf(_9
Legal Description: .! 3 'F C
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Property Tax 1D #: /117 Cd - / 1. e
Site Plan Name-
:Project Name:
OY- 04 I
RECEIVED
APR 13 2018
Permitting Department_
Z Lyci�iCounty, FL
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from dropbox, click arrow at the end of line C OR -'O s
YY ly 6 Z-2� ZZ42
'Lot No.
641 Block No.
Setbacks Front Back: Right Side: 13 Left Side: A"
DETAILED DESCRIPTION OF WORK:
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ch
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CONSTRUCTION INEORMATION
Ad mona I worK to a-ve orme ; un ert is permit-c ec a apply:,
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0HVAC Gas Ta nk Gas Pi
Electric Plumbing 0Sprin1
11 -d
Total Sq. Ft of Construction: /
Cost of Construction: $ _J� eQ 0
ing - Shutters u Windows/Doors
?rs Generator 011oof
S . Ft. of First Floor:
Utilities: Sewer 0 Septic Building Height: �y /
OWNER/LESSEE.... =
::CONTRACTOR
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Name f)-o1y1 a
Name: rs
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Address •
Company: r
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c•,�y; ,� I State:
Ad- dress: CO3 cz
Zip Code: �3 S-j iFax•
City: Ff (CK-e
State: /-C-
7 % �-� 1�e;
Zip Code:3,
t Fax:
Phone No. /. -
E Mail:zt'.-
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail: Ce
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from the Owner listed above)
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State or Coun 'cense:
II If value of construction is Fsuu or more, a KewKuw Nonce or Lommencamenz o r"wAls ... �I
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77-
'SUPPLEMENTALE`OiVST�tU O.N L!E m W1, FORI�IATIOh
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: %Y1_a;�2q-S /�e-/L
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Name' -
_
Address: / -3 ,3 4 5-g-f
5,1,j;2�o
Address:
City: C- -"f G✓-L /r�'
State:
City:
State:
� Zip: Z (,eQ— Phone 7,,,,L
�z JS_ 5 .2-, fo
Zip: -Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name: i hV(
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!
Name:
Address: / 1- 9-Of f ,5 ti
/,a.1 /`
Address:
City: 6x c Zeyy i
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto do the work and installation as indicated.
I certify that no work or installation has commei ced 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 herebl- 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 acces"sory 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, con ith I rider or an attorney before
commencing work or recording vour Notice of Commenceme .
Owner/ Lessee/Contractor asXgent for Owner
STATE OF FLORID!S�)4. STATE OF FLORID
COUNTY OF COUNTY OF
The forgoing instry ment vgas acknowledged fore me
this day 20y
The forgoing instru ent Kiss acknowledged efore me
this _& day 20 10 by
(Name of person acknowledging)(Name of person acknowledging)
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(Signature of N ry Public- State of Florida) cN q (Signature of ary Public- State of Florida)
Q� FM
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Personatiiion
OR Produced Identificat°� Personally �� OR Produced Identification =
Type of �' Type of Idi'-wiCai►�— =�
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asp
Produced �N Produced
Commission No. (Seal) Commission No. (Seal) a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED h �, A
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