HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAhk
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Date: Q Permit Number: �go-�-•��V� - -
- SCANNED
__ - _. WON-_ guy ing Permit Appiication se. Luce coun
I Planning and Development services Ty
Building and Code Regulation Division
Virginia -Avenue, -Fort Pierce FL 34982
I2300
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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IAddress:
Legal Description: 1115 ¢ �-G I1rY[l�V�Q S� ply
Property Tax ID #: ��� la n 3, 0 d an _ 060 - -1 Lot No.
Site Plan Name: 2a.n[J1e Block No.
Project Name: �� V—du F'.p�AkAAk
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Isetbacks Front . Back: Right Side: Left Side:
UE r L [D �SCRfPT10 OF K.
olre.
ttlona war to a pe orme un er t is permit - c ec a t at app y:
_Mechanical _Gas Tank _L,3s.RW%v _Shaaers _Wfnabws/Doors
_ Electric _ Plumbing _ Sprinklers —Generator , Roof Pitch
TOW Scy. Ft of Cvmbuttion: Sq. Ft. of First Floor:
Cost of Construction:$ '22• U Utilities: _Sewer _Septic Building Height:
Name Name: �La9Nefs 5 0
Address :ComI
�ft__��
City: ��2! c a, State: i' AddrZip
Code: � Y � Fax: C7tp:
State:_Phone No. a ^ 6 -ot -114A 3-7 3 Zip CE-MaiL
�/O-. eq�Cs 1i3�j � rphonFill
in fee simple Title Holder on next page (if different'° E- a
from the Owner listed above) State or Cou License
I
If value of construction is 2500 or more, a RECORDED Notice of Comm cement is required.
N
R PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: Not Applicable- ---
/ PP
Name:
IVIORTGAGECOMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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,
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
commencing work or recording our Notice of Commencement.
n �—Q0AJLAn
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA� ,
STATE OF FLORIDA
COUNTY OF off%% r �s
COUNTY OF
The forgoing instru t was acknowledge before me
The forgoing. instrument was acknowledged before me
this ���c�dayoof 20by
\
this _ day of . 20_ by
" Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id tification
Type of Identification
Produced Qu kk-
Produced
(S' nat re of Notary Public- Stat of Florida)
(Signature of Notary Public- State of Florida )
Commission No. G
Commission No. (Seal)
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• December20.21122
REVIEWS
F , sSR�•
muf�
FNU
YSUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
s`
DATE
COMPLETED
Rev.t1/Lo/la
All APPLICABLE INFO MUST BE COMOED FOR APPLICATIO TO BE ACCEPTED
Date: Permit Number:
- �- Buildin Permit Application
Planning and Deve ment5ervices
Building and Code Re ulation Division_ -
2300 Virginia Avenue, rt Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CO mercial Re ' ential
PERMIT TYPE:
PRO .SEDINPROVEMEN LOC TION:
Address:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
0. EPAI 111 E DI DESCRI PJT1ION 10F WORK:
CONSTRI111 ION' I FORMATION:
Additional work to be performed u der this pe it — check all tha pply:
_Mechanical _GasT nk Gas Piping Shutters _Windows/Doors
Electric P mbing Sprinklers —G ne�ator _ Roof Pitch
Total Sq. Ft of Construction, Sq. Ft. of First F or:
Cost of Construction: $ Utilities: _Sewer _ eptic Building Height:
OWNER LESS E
•ONTRACTOR:
Name
Name:
Address:
Company:
City: tate:_
Zip Code: Fax:
Add�_
Cityi .1,,.. :vnrt :-n,.1:,!Ks: ::,':•., N State•
v ^ : ''
Phone No.
Zip
Ph6 e'No-
E-Mail:
Fill in fee simple Title Holder on next page ( if erent
E-Mail
State or County License
from th Owner listed above)
If value construction is $2500 or more, a RECORDED otice of Commencement is required.
If value f HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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