HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICIBLE INFO MUST BECOMP_a iD FOR APPLICATION TO BE ACCEPTED ,
Date: 1 U ' �� Permit Number:
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Planning and Development Services OCT
Building and Code Regulation Division 3;� Z018
2300 Virgi6ia Avenue, Fort Pierce FL 34982 PermtI
Phone: (772) 462-1553 Fax: (772) 462-1578 CommercialIPig9 Npartment
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PERMIT. APPLICATION FOR:
Address: Zi—:-x 0/z- i P/,oi�(LC, FL 3y
Legal Description:
Property Tax ID #: Lot No.``
Site Plan Name: 01--o D.Y s r6a6y 5 6 al AL I -6 0 81V5d A) Block No.
Project Name: f L-fL 6 U50 ✓y
Setbacks i Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Ga;
_ Electric _ Plumbing _ Sp
Total Sq. Ft of Construction:
Cost of Construction: $
liping _ Shutters _ Windows/Doors
nklers Generator _ Roof Pitch
Sq. Ft. of First Floor: N/9
Utilities: —Sewer —Septic Building Height:
O NER L =SSEE
C�QNTR�A OR•
Name _f}L��bfi,+VaN
Address:
City: ( D2T rG2C State: r�-
Zip Code: qq w:: F'ax :�.:... "�..
Phone No. 77 2 -'30 l - / 6
Name'.
Comdan .r.CS�o�� G712/C
Addr ssy 7-1�19 C�;'7 �1�y iZr %c
City: V G 77JG4q State: rC
Zip Code: 3z.q 66 Fax: Z 7 Z - 7 9q -7-M
Phone No 7 77— ` 56V ` LZI 5
E-Mail: /1/ PF
Fill in fee simple Title Holder on next .page if different
from the Owner listed above)
E-Mail U.S GiJvt, CC) M CAA S 7 , DV 61
State or County License rC/ 313® C L Z 7-
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
(7 - ..
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ L Not Applicable
Name: Name:
Address: ! Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPILE TITLE HOLDER: Not Applicable BONDING COMPANY: -Not Applicable
Name: Name:
Address:) Address:
City: City:
Zip: I 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 followinlg building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory sti uctures, 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
improverrients 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.
Signature bf Owner essee/Contractor as Agent for Owner
Signature of ontractor/License Holder
STATE OF FLORID,
STATE OF FLORID
COUNTY OF w.
COUNTY OF
The fora[g instrument as acknowledged before me
The for ing instrum nt w s acknowledged before me
this May of 20 frby
this ay of 20ZIby
GC) Y S. 010 0 a-
GOV S, /moo n-6
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
Produced
Produced
I
(Signature of Nota ublic- St of. F o '
(Signature of Notary'Public- St of_Florida )
.WILLIAM SURGEONCommission No.'''_MMISSId1'a 136489
Comm s .. WILLIAM SURGEON S I)
EXPIRES: August 28, 2021
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MY COMMISSION # GG 136469
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9 IN
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ry Public Underwrfte_rs
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REVIEWS FRONT ZONING SUPERVISOR
PLAN
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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