HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �i �1
te: �7'' Permit Number: a d D — 03 q
Building Permit Application Oct 16?
Planning and Development Services p OJe
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Building and Code Regulation Division S /ttip9
2300 Virginia Avenue, Fort Pierce FL 34982 t Lucie Cg nsent
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential y
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPR`O'VEMENT LOCATION:
Address: /v 6; rla /, fiW S c "C 3 Vg 5�
Legal Description: Vg
Property Tax ID #: S"yi� O D / S_ D 00 a =�1 _ \ter Lot No. 1 s
Site) Plan Name: i�seVNED Block No.
Project Name: _BIZ h(e Z my �Iwv a+,.....,a.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
04(" ext.-SI." A*A V pw�-2 v raploc-e- MJ/ t4,01�151+v
S V Base 4L 5l4P r%lo oil,
CONSTRUCTION INFORMATION:
itiona wor to e nej orme under this permit — check all apply:
— HVAC L_I Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof I Roof pitch
Total Sq. Ft of Construction:?) bU S . Ft. of First Floor:
i
Cost of Construction: $ `o�, �� Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i/1.t22.,
Name: k^ A
Address: OV
Company:
.41, •F /+ • L( (�
City: 0; i Sr �t.., a State: I
Address: 6 SW.
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Zipl Code: 3 Y 9 Sa Fax:
City: Pcie+ 54. State:
Phone No.�S%. - %
Zip Code: 9 Y
Phone No. ? a
Fax:
a i al
E-Mail: R tyl 790 a a: � • Lur»
E-Mail: A by p;tig
C (P Ci�,►'It�4. wW�
Fill in fee simple Title Holder on next page (if different
State or County License:
C C C. 1,33 13.2 (j
from the Owner listed above)
IIIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
ZV Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City City:
ZV 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. Ll,ucie 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 t fi st inspection. If you intend to obtain financing, cprrs-074 with lender oran attorney before
commefficind work or.recoMinia vour Notice of Commence nt. J /
vlow
Signatu a Own 611fesseEVC0ntractor as Agent for Owner
Sign tur of Con or/ cense Holder
STATE OF FLORIDA
S{� L-CAk
STATE OF FLORID
C ��
COUNTY OF _
COUNTY OF > c
The forgoing instrument was acknowledged before me
The for oing instr�{me t was a knowledge before me
I r W
this day of QCeV ?p�� 20 by
this day of tJ 20 It by
�bla F�cO\rQ �-
-6 ycC n1ak
N e of person making statement
ame of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id e tification 1
Pro duced ���C \ C p/r �
Type of Id tification
Produced�A k V`0-f_ V i 00S'e
(Signature of Notary P lic- St of Fip� da) Christian A. PIi
gtESignature o Notary Pu lic- to of Florida )
_°'�'p��°�, Notary Publ
Commission No. 8a L O }`ekl) State of Flori
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jFommission No. as Li`6Ll Y pie (Seal) Christian A. Pringle
My Commission Expir
s 04/27/19 *° -* Notary Public
p100
State of Florida
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
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SEA URTLE
Toffmiaion Expires 0
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
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DATE
COMPLETED
A
Rev.18/2/17