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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION71 s �
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED' i
D' te:
0 O t p SCANNED Permit Number: 1 0 0 0 'Cns o
BY
• St. Lucie COMP
191
Building Permit Application JUN 27 ,,dmY pt
PI nning and Development Services permitting D Count
B ilding and Code Regulation Division
St. Lucie
2 00 Virginia Avenue, Fort Pierce FL 34982
Ph11 one: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
W
P
RMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Pf,IOPOSED
IMPROVE MENT�LOCATION ,,.: .
Adiress: `-)d o I . eLy- .18 r►' A&e, � � lr % �Ci , ✓� � 2- U G� 'lO e- /rZ6
Legal Description: S L; r, v, �^ �h 0 A S If
0f T4 404 J) ?
I
Pro ertyTaxlD#: 060_�- D U of (-6,clo— / Lot No.
'Sit: Plan Name: Block No.
Project Name:
Se�backs Front Back: Right Side: Left Side:
D :f .AILED DESCRIPTION OF WORK:.
C u� l' _ OS
YlaL�sti
CONSTRUCTION INFORMATION:
Additional worK to b rtormed under this Permit— check all apply:
[1HVAC Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
LL_I Electric ❑ Plumbing sprinklers ❑Generator Roof Roof pitch
Tot I Sq. Ft of Construction: v! 02 S . Ft. of First Floor:
�v
Co I� of Construction: $ ��(1!/t/. Utilities: OSewer ❑Septic Building Height:
O„
NER/LESSEE:. ...
CONTRACTOR: r
I
Narjie
Address:
city:
Zip
I
Phc
E-Mail:
Fill
)4 u w� D f r i'
Name: 2 2 vt
Company: P0 %e t&
Address: ( t/ l= V $! c F G C) v i
6i U) /Vi a r A
A i (el, n l u cl: c State:„
Code: 3 I�.� b Fax:
ne No. '? of % a A Ll fY 7
City: a r fs�r• h f State: '
Zip Code: 3 z� �*6, 3 Fax:
Phone No. '% 7aL— �d Y— 0
E-Mail: %L 40c) � h j 0 1 A C (ate 'Gu
fee simple Title Holder on next page ( if different
frog
the Owner listed above)
State or County License: G CC 13 3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
1 UPPL�EMEN.TALCONSTRUCTI:ON•:UtNI LAW.INFORMATION: .. .
1 .,.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
.11
Name:
_
Name:
Pddress:
Address:
City: State:
City: State:
ip: Phone
Zip: Phone:
EE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
ame:
Name:
Address:
Address:
City:
ity:
ip: Phone:
Zip: Phone:
OWNER/
CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I'
ertify that no work or installation has commenced prior to the issuance of a permit.
S
w
. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
iich 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.
Tf
ie 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
ANARNING
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
'rst
before
the inspection. If you intepid to obtain financing, cons with lender or an attorney before
c
o W
mmen In ork or r ordi our otice of Commencement.
h
$ignatu
Owner/ L se /Contractor as Agent for Owner
Sig re Contractor/ c nse Holder
(STATE
OF FLORIDA
STATE OF FLORIDA
OUNTY OF e
COUNTY OF Sk �o .
he for oing instrument was acknowledged before me
by
The forgoing instrument was acknowledged before me
this )A, day of 20 1 It by
his day of 2011
l
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type
of Identification
Type of Identification
i
roduced
Produced
ltwdnat6
of Notary Public- S e of Florida)
(Signature of Notary Public- StRe of Florida )
Commission
No. �_ �.� (Seal)
��� LASHAHNA INGRAM
<< d r
ommission No. 1— ;•„ „. ----=i=(Seal)_ ,,.-
; s�P e;- LASHAHNA INGRAM
�: Notary
.� eo
Notary Public - Stale of Florida
, _ Public - SYate of Florida
=; °� My
n Comm Fyni�o n-_
;REVIEWS
;• a
FROM ''%;�01
, • any uomm
Q.
f iVING d �hrcug
rxpires uec u, c
���rq
PER ISOf s
LANS
Jnp
�,9 �.�:
OF F40 `�
��''
VEG
Commission #
� .
n1fURTI,F3tiona�i
F 1772 o ��
R©VE
�iCOUNT
a ilk .:
RIEvZrEVIEW
REVIEWt
fE. 5�`J1/
4ATE
RECEIVED
ATE
COMPLETED
Rev.
8/2/17