HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (
Date: 9—� Permit Number: lJ� G v- d2x__P
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Building Permit Application OCT y,.il
Planning and Development Services ��
Perme zb
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Building and Code Regulation Division sty 6y�1 "Partment 9 C
2300 Virginia Avenue, Fort Pierce FL 34982 ti coutlty / 0(/� fly
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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19. /�:
AMA-4-6 W-A90015 Lot No.
Iliiwo'G1 �! _�.Block No.
AT _ � %�
Setbacks Front_ � n /_ Back: $ %.. Right Side O� Left Side: I
Additional worK to De ertormea under tnis permit — check all apply:
E1HVAC Gas Tank Gas Piping In Shutters
Electric ❑ Plumbing Sprinklers ❑ Generator
Total Sq. Ft of Construction: `
Cost of Construction: $ la Q(J
S Ft. of First Floor: _
Utilities:Sewer 1:1Septic
11 Windows/Doors
❑ Roof Roof pitch
Building Height:
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Name C> �EA QJ
Name: liiq 4,1;
Adc ir s: �� ' r1w
Company:
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City: State:Fl
Zip Code: O Fax:t'14 `
Phone No.
Address: (�
City:
Zip Code:
Phone N - �3
Fax:
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State:
E-Mail:
Fill iIn fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: 'r
I it value of construction is �z500 or more, a RECORDED Notice of Commencement is required.
. .... ... . XiT, NA, INFORM
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
i
Address:
Address:
city: State:
City: State:
Zip: Phone
Zip: Phone:
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 ancovenants 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
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in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The ollowing 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
complencing work or recording your Notice of Commencement
WAI
Signature (!wneri Lessee/Contractor as Agent for Owner
Signature of Cour ctor/License Holder
STATE OF FLO
COUNTY OF
STATE OF FLORID�hW ,
COUNTY OF tj
Thle�f�ing mstru(7entT3s aclknowledgqd before me
thisay of 201 Z5' by
The for oing instrument was acknowledged before me
this day of 4!)Q-A- 20_0by
�\); (2-T
(2EA't(� -R; C_�
Na of perso making statement
1\6�e of perso making k* statement s
Personally Known OR Produced Identification
Personally Known 1-1 OR Produced Identification
Type of Identification
Type of Identification
Produced A
Produced
(Signature
.public- Stgltv @.W90*)
(Signature of
Commissio
MY COMMISSION # GG 009363
111111. "'RES: July 6,
Commission N
P
i BEV L. HADDAbD
1;. ... ' MYCOMMISSION#fg 363]
:.!
E6,20�2:0
Bonded Thru Notary Public Under0ters.
_kW6363
-EXPIRES: July 0__
VF�,op' Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.'8/2/17
BEV L. HADDAD BEV L. HADDAD
I P, M ON # 00 COMMISSION # GG 009363
GG 9363 1 Myr
MY Go MISSION # GG o09363
A m ISS July 6, 2020
July EXPIRES:
PIRES: July.6: RqiVS,,ded Thr- Notary public Underwd
X . E ES.