HomeMy WebLinkAboutBUILDING PERMIT APPLICATION/Fr
ALL APPLICABLE INFO M qSTBECOMPLETED FOR APPLICATION TO BE ACCEPTED
/
Date:
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Permit NLnOCT
IVED
Building Permit Applicati1.8 2018
Planning and Development Services De
Building and Code Regulation Division partment
2300 Virginia Avenue, Fort Pierce FL 34982 C nty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IM,PROVEIVfENT LOCATtO,N ` �r t}
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Address:F ��/ �1-�I_�/�1]' L.T-N GQAIVN
Legal Description: J12665 686Ei' 8615S IV L.07- /59 BY
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Property Tax ID #: 3Na9 - 70/- 66/19 - 6600 - Lot No. _
Site Plan Name: 61AAM/A22 14&�/A [-/X� Block No.
Project Name: &A1L1-15/A2,A ETSInt7U6!�
Setbacks Front 31(P, (f2 Back: I Right Side: 122.qgLeft Side: _42Y�IP8
DETAILED DESCRtPI`ION OF WORK L c 4
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CONSTRUCTION INFORMATION
itiona wor to e e orme un ert ispermit-checka apply:`
QIHVAC0 Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers O Generator Roof Roof pitch
Total Sq. IFt of Construction: S . Ft. of -First Floor: �3
i'
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Cost of Construction: $ Utilities: _ Sewer ®Septic Building Height: 21
0111(NERpJLESSEf x� ' r
C 0 NTRACTOR
Name:
Name S
Address:. 763 SGt) t"-i�L,/iS%�`/1i7 �if"-
Company: &114bCZS. 'L4Q
Address: JaW�1�f1T�fili�T LI�IUL
City: 61n4 State:
Zip Code3ggq6 Fax:
City: F LState:rt `
Phone No. r5%� �9�- ,?33 "%
lP
Zip Code:y(� Fa 77Zi4&,,,s 10
E-Mail:Tljjz)!;F' m)lit) aj L/1/I -eoAl
Phone No. --) -o2 2(p -
Fill in fee simple Title Holder on next page (if different
E-Mail: I r F-A )in-OJ ; A T
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:Stri/EUl ' Z % I -D VA
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Name: A)7£2? l t)
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Address:
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Address: T.k&d11-L(JI-ST,3Lu
City: L Pi'--
State:
City: O T g-. Qe(t
State: rc
Zip: Phone 77
7 -
Zip: ' wild Phone:
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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,
accessoryi 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 your Notice of Commencement.
' . I /T . Aa"J��
Signature of COVner/ Lessee/Contractor as Agent �—, Signature o ontractor/License Holder
STATE OF FL
COUNTY OF.
The for ping instr nt was
this day of_
��
Name of persaking statement
Personally Known OR Produced Idi
Type of Identification
Produced
(Signature of No ry Public- State of Florida )
Commission No.
REVIEWS
DATE
RECEIVED
DATE '
COMPLETED
Rev. 8/2/17
efor @2(g
by m!C -
�2 2
(Seal)
STATE OF FLORIDA
COUNTY OF,
The f going instr ment was acknowledged before me
this day of a . 2W by
r" e'CPV,
Name ok person making statement v
Personally Known OR Produced Identification
Type of Identifin ",,
oG YENIA NOY•BARRIOS
��� Notary Public, State of Flor
Commission# GG 57808
My comm. expires Doe. 22.21
(Signatu )otary Public- 3'1'n'8f'-1 ' -a I —
CommissionNo. &02C) (Seal)
FRONT ZONINGANGRO
COUNTER I REVIEW I S REVIEW UPERVISO!I REVIEW R PLANS I VEGETATION
I S REVIEW I M EVIEWVE