HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPDCABLE INFO MUSTSCOMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 �d.l i I Permit Number. � ''1 1� \_6 J l t'�•
SCANNED
RECEIVED SEP 22 2017
BY
Building Permit Application St.
Planning and Developmenr Servkes Lucie County
Building and Code Regulation Division
2300 VirginigAvenue, Fat Pierce FL 34992
Phone: (77Z) 46Z-1553 Fax: (772) 462-1578 Commercial 11z Residential
PERMITAPPLICATION FOR: To Select from dropbox, dick arrow at the end of tine
PROPOSED IMPROVEMENTLUfAOAFr."`,; :w
Address: J o,rl/ UI —4
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Legal Descdpdom Q A7S• 40
(--�41Li, -r'ibi -ISN- IAW 0
Property Tax ID Lot No.
Site Plan Name: N I Block No.
Project Name:
Setbacks Front_ Bac1t-_jj> _Right Side: Left Side:
DETAILED DESCRIPTION,OF;,1NpRK�'•::,�F=:;�;'��:�.> ..':r_:��::'.....�!•:,J;"a'::C'"=::<,=<;:.';`::,;..:ii: .
C%/A.fAG'/2G'dL �'?e%/ErJ Hone
CONSTRUCTION-JNRMAI'fL7iVE.:'.`^.;<;>< '�=:,,_:
Warm
:..:.::- .',_'1='_::rP;:,_,:•:=;� ;�..,;_>,.,_
moria wor to u un er is permrc-c ec a app .
QHVAC ��`• Gas Tank [:]Gas Piping
Shutters o Windows/Dours1:1Electric
Plumbing Sprinklers Generator Roof Roar pitch
Total Sq. Ft of Construction: S Ft. of First Floor.
I,9�
Cost of Construction$ Utilities:'nSewerElSeptic Building Height
OWNER/LESSEE: "i' :LOWTtiGG16R ;• _ ;.:%
Name'—PI,ai i zYZ L `
Name: 4_ o i
Address:,()• .cu R
Company. UA t,_ Qu.11 •f -y ?T
City: h pli-i -Y2 Kre state;
Addres3, rF T
City: /A>'^10-4 State: K
Zip Code: I I G(9 5 Fax:.Ti(fo '7 7$K6i L
Phone No. S((o SsSSI
Zip Code: 33olo Fax: 3oS'3dt2 qa oL
E-Mall:
Phone No. 30./- 9g,P S.Sa3
Fill in fee simple Title Holder on next page I if different
E-Mail: �+ n or./ e+
State or Co ry censer G•rFG/�/cf;y'2
wn
from the Omer listed above)
If value of construction Is S25GO amae, a RECORDED Native of fvmmencement is required.
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-SUPPLEMENTAL Cf3N5TRUCTJO
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NaESmle NER/ENGINEER: Not Applicable
N R;C"AGE QIMIP ANYR t:- Not Applipble
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Address:
Address:/—
City: State: _
Zip: Phone
City: State: _
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
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 authorise the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,�bylaws or an 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 -
Inconsideration 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 usesto 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 IRfider or an attorney before
commencing work or recordine vour Notice of Commencement. /Y 14.
Signature of0 n r/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�f
COUNTY OF
STATE OF FLORIDA
COUNTY OF%. l t JCA t
The forgoing instrument was bcknowledged before me The fa Ing ins
� thisday of 't- 20_n by thisiTdayof
&lieu q M 61f�1o6
Name of pe akingstatement a t
Personally Known terOR Produced Identification Personally Know
Type of Identification i is
Commission I
i
REVIEWS
DATE_
RECEIVED
DATE
COMPLETED
Rev.8/2/17
a, V)""
acknowledged before me
. 2QLI by
Identification
rotary Public- re, of Notary Public -State of Florida
GHACE A.WARNER - -'
($t*MMISS10Nl FF234c95 mission No O •
•, •i EXPIRES: September 22, 2at r„ Nl
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FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW
MANGROVE
REVIEW
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