HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: j�,'y-IS Permit
"DUANNED Number:
t BY
c - uriP County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: MI.
Legal Description: L,A-N'� LY'Nb 'N �1tfL,i of s o 2�-� TwP 3,b SovTA
Property Tax I D #: 3 32 a- - 900 — 0001 — 00014 Lot No.
Site Plan Name:_5;TE 3F'VLD217.EN7RGA-r4 FOK Pg.&W"A6 cju9^o4Block No.
Project Name: /✓Ew -Vi iTlOri tot ezv0*V,S;F
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
s'zNc£ io dl inj6 Gpoc E 2 Arlo $b�.J` Izi) q{� �r1TPA w7c� . 1 Pi42TrG�Lb�
i .(lam I'f.A30N iLy G�Lvr-i e�5 i T�� L� .S✓�i'OQj 7-444-- yi P4y4 P404ELS ,
CONSTRUCTION INFORMATION:
rtiona wor to e e orme under ispermit—c ec a a appy:
❑HVAC �GasTank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: JTj0o>`. 90 t-F S Ft. of First.Floor:
c'
Cost of Construction: $ 0 Utilities:Sewer ❑Septic Building Height: 8 YT.
OWNERAESSEE;
'CONTRACTOR:
Name 1 �£S,✓{tvE irl Name: 4Cic Az-o—jt✓E
Address:_,ff 14 RF6c; aiz. Company:_ wAj6i�Zvcr;on
City: SO fZT lJc State: _ Address: -70 ( ttypq tP -PC,N i PAQ.kvj.A-y
Zip Code: 34984 Fax: City: kkL PPLH __< iA- Stater
Phone No. Z) 46,77 — 13co Zip Code: 33¢0Fax:
E-Mail:_,JT1= Py (+') 1%14N@ c o ri Phone No. 6l 49, — 2-91 a
Fill in fee simple Title Holder on next page (if different E-Mail: E ?Ly i I<.E C0 /�M i II✓ i G7 t�J+j
from the Owner listed above) State or County License: g2� 15-1 9G 43
5L-C 2 S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
City:
Zip:_
FEE SIMPLE TITLE HOLDER:
City;
Zip:_
Not
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Phone: r
Zip:
—Not Applicable
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.
Is In conflict with any applicable lHome Owners tAssociation rules bylaws or and covenants holder
tt build
ay 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
commencine work or remrdino vnnr nlnr:ro c r........__
enatur fOwner/L see/Agent
cement. V
Signature of Contractor/License Holder
STATE OF COUNTY OFORIDAST. LUDIC: Pal
STATE OF F60m
Beach
COUNTY OF a
The foing instrument was acknowledged before me
this [a day of A�n I 20 15 by
► rnnrn,/ I errs
(Name of person acknow edging)
(Signature of Notary Public- tale of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced r —AAQJA E. SCHRADER
Nr MY COMMISSION#EE847629
Commission N I EXPI luary7.20i7
-,R rti 9a�dedThPubGsUndermtem
The forgoing instrument was acknowledged before me
this dayof April 201$by
Cynthia Perih
(Nam- of n_�q acknowledging)
(Signature of Notary Public -State of Florida )
Personally Known X OR Produced Identification
Type ofldentification
Produced
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Commission No. y?� Lr, Lrolnk u.:ou
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