HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ad SCANNED Permit Number: I1601 dos y
BY RECED SEP Z 0 2017
St. Lucie 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 !� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line \)"•,,A 6�t1 < I
Address:
r• '�a�iC.Ti��liLRi ilw!�t`Gitlsiil;t��sa • -
PropertyTax ID #: Lot No.
Site Plan Name: (' hf- 1e' n i��Cl P11�_ Block No.
Project Name: ChPj-)e I�iPI"Y�t�
Setbacks Front Back: Right Side: Left Side:
•-?tecv e car1d repjc�ce (.-7) such ng glass doors
CZIF-iXcd wlndOWS,
Norl -1 i- e
taus '4 M ;� xks 34 FL e '� � xsy, .gyp
% t '�' � 1 `i r eke
CQNStiti CffAi }NF 3. 1 FAT�t i . M° L t t • °. € �EM
rtiona wor to a of orme un ert is permit c ec a apply
�HVAC Gas Tank ❑Gas Piping _Shutters lb?nWindows/Doors
Electric 0 Plumbing 0 Sprinklers 1:1 Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction: Sc Ft. of First Floor:
Cost of Construction: $ ��CM ' CO Utilities: Sewer Ej Septic Building Height:
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Name (1y)ff let
Name:T(Zpiri I_CAPffikt-
Address:_gtgM S. TJY( ) Jni+ q0 i
Company. ti SS`�4`
IC i(� I .
City:,1C!nSPCl P)l?Q0 h State: FL
Zip Code: 2495-7 Fax: Zi (}
Phone No. '1QC1. -31),p
Address: 3)n
WV, =i
City: s-rtAar± , ,
Zip Code:
Phone No. a8tn— 04415Q
" me State
Fax: = 2810 ' 041.61
E-Mail:ic�m .riiFrK1P1 YIQ4D.[c�(
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Fill in fee simple Title Holder c�n-next page (if different
from the Owner listed above)
E-Mail: pemitr, r.1nSc
isro g Qonyts
State or County license: 1
q -;�t03
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE
OWE ER/ CONTRACTOR AFFICIVIT: 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,
S#, Lu6je Gaunty makes no represent tian that Is granting a perrmit Will authorize the permit holder to build the subject structure
which is Ih conflict with any appiteab�a 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 contideratloh of the grehting df thlt 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 buildilig permit bpplieAtians ara exempt fforn ungergoftfg a full concurran y review; room additions,
accessory structures, swimming pools, fdnces, well's, signs, mfo@h rooms and accessory uses to another non-residential use
WARNING TO OWNER: You ilure to Record p Notice of Cemrnenccmwnt may result fit y r paying twice for
improvements to your pr .e y: A Notice of Corrimefterrieht mutt be recorded en ted on the jobsite
befor he first fnspectlo :1 you intend to obtOlh financing, consult with lender tl an ttorney before
co' n,e w' orr o In our,Ntstice,O.fCcirn e .
Rev.B/2/17
COMPANY:
.�. Not Applicable
Name:.
Name:.
_
Address:_
Address:
City:
State:
City:
State: _..
Zlp:. Phone- -
_ _-__ -- ----
Zip:
..Phone:_..
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FEE SIMPLE TITLEHOLDER:
�, Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
City:
Address:_-
City:
Zip:
Phone:.
Zip: _ Phone:
Wignaiure of owner/ Lessee/Contractor as Agent for owher
USIgnaturI&C.
tractor/License Holder
STAVE. ®F FLOftlbq, �
SPATE OF FLOR! '
COUNTY OF. TY 1(]%fln
COUNTY OF . .I/��1�)
The forgoing instrume�5t_ w��t�knowlefiged before me
The or binglFisfr mentwas ackn wledggd_before me
this day 20�] by
this ?,�day of 20,]I by
o
Name of perso aking statement
Name of person king statement
Personally known OR PrIm oduced Identification
Personally Known R Produced Identification
Type of identification
Type of Identification
Produced.
Produced
-
(Signature of tart' Public- State of Florida)
(Signature of Not Public -state of Florida )
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Commission (KELLY WI(�j.
' 'v c'• KELLY WIDMAN
,°1.^P "�e'••,
o '�s Notary,Publlc - Stateof Florida
a+ • o. Notary Futile -state of Florida
'�� Commission k FF 929255
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SUPERVISbR
PLANS
V
OVE
REVIEW
REVIEVJ
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REVIEW
DATE
RECEIVED
'22'
DATE
COMPLETE!)