HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONk'
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED(
Date: Permit Number: �UC "`y �
BY
Buil i ftG01hpiplication
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: To Select from dropbox, click arrow at the end of line
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Address: 2314 A'11pf+1-t;C �.3�C41 II'�y1, � aiEQL�. �1.. 34q��
Legal Description: L•0T k1b , P-SLK 4Jt7 1 2C Vis&t_1 PL4T of 4:r P&r=eCx_ _41 "ags
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Property Tax ID #: LyS6 — (O3— WZ9 _cm`Z Lot No. % RO
Site Plan Name: Block No. 30
Project Name: Oft0 V. %Z6S%0GTAC.i-
Setbacks Front ' Back: Z el Right Side: 2 A-63 Left Side: V-CJ
is xr, L1b ® S-t=�b m . cl3S 2'3Za s-� L kJ `32 ZZ S _A�
jjLt'IHVAC
LJ''Electric
_ L Shutters
12rPlumbing Sprinklers Generator Roof /2 Roof pitch
Total Sq. Ft -of Construction: ZZ�
ost of Construction: $ 'Z
SgFtj of First Floor: _
Utilities: LJ Sewer H Septic
Windows/Doors
Building Height:
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CONTRAC�tOR.
.
Name_
Name: (b2A0t*_%01LL* i•ka--z"tX'5 O-* t
Address:1Z2 &Af" ADN 19T Ur4rr r_�',
Company: MWO C-ZO GALA S
City: FoAa V11-r-km State: _*L-
Address S"D PA -Mtrm LO LM
Zip Code: _?)c4 PAL) Fax:
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City: Ner QT 1_-_AC. V& State RCS
Phone No. '5ZI — Si`:" C.0 Q�_
Zip Code: '54 q 6 L Fax:
E-Mail:_ 1091:4, kr Q ff�& ,.J(S
Phone No. A61- 'Z 2 — U g
E-Mail: MtAV0L% t 3W"I LO.a
CIS !
Fill in fee simple Title Holder on next page if i ( ferent
from the Owner listed
above)
Sate or County License: C-dC !SO 0
iT vame oT construction is ,SLSuu or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION$LIEN LAW INFORMATION f
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 1 � (= I
Name: SA9�i�O_AkL
Address: _ ems
Address: \ t,,\"J Q'r
City: State: �
City: State: 7E�i—
Zip: g Phone-`%-1.—L—
Zip: *S ^I 4. Phone: nnz— 'IQl
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.
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 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.
Si natur r e of Ownessee/Contractor as Agent for Owner
Signature of Contractor/License Holder /
STATE OF FLORI�At'
COUNTY OF 1
�Va�
STATE OF FLORIDA J
COUNTY OF_,,J+•
The forgoing instr Rent wa acknowledgd•�efore me
The forgoing instr ent wa acknowledged before me
this day of 20 ?S by
this 30 day of i 20�5 by
Name of person making statement
Personally Known OR Produced Identification,_
Name of person making statement
Personally Known OR Produced Identification J�
Type of Identi 'cat'on
Produced
Type of Identification,C�-�
Produced
- ----
�� NN HOOD
(Signature of otary Public- State of Florida)
(Signature otary Pub, a *a 8 u e - state of Floric
'• • •: omission
a
Commission No. a'�-3 (Seal)
• # FF 202265
a��
Commission No. %� FFYga�°o'� MY �11 Explres Mar 17, 20
9
Bon�aTf-iraUgh National Notary As
n.
�+y4"Ls;'•; MONICA SIMS
Notary PjVcc - Sta
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9 e F o•da
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REVIEWS
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expires
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
67TT7
RECEIVED
DATE
COMPLETED
• Rev. 8/2/17