HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE IIN7c
FO LI T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: `-t" 1 [ ' SCANNED Permit Number:
BY
St. Lucie County
owmaommommommommo Building Permit Application
Planning and Development Services APR 17
Building and Code Regulation Division / "enni ^1#1B
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial `� Residential � �u 11) eCoo „Iyeet
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
01
Address:
Legal Description: EmmDHSS ConCicMiniLlrY) i.Ani-i: SOR
Property Tax ID #: 45oa— %ao-
Site Plan Name:
a-om0-
Project Name: y i sSCher
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: SVIUj}eY ` -CVM'fi #IW3- 0-77'S
ze l ve and replace (2) i nri pact- si ngill?_ +(U• ri9 �✓
windows and (a)non-"Impact �lidltl C�IaSS'c�U�UU�'S
s huLtArY PerMil 0WIP01 selm
CONSTRUCTION INFORMATION:
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�HVAC Gas Tank Gas Piping
Electric 0 Plumbing sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 'A ()00
apply:
Shutters Windows/Doors
Generator Roof = Roof pitch
Sq��Ft.I of First Floor: _
Utilities: ! Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:.
Name earl, r.rh��r Visscher" °
Name:,
Address q�OQG� .C3 Yl /I�r\' (,(Yil�'80
Company:�i
Gty, JF'11_C[—t l��y�'a{J�l'7 �Yi a �. State:
.•• tDv'i b7 _3 ...
Zip Cod�a: e:QrJ%` x7 fSP /
Phone No.J
Address: 3/ < <C.�
" L, if iri«J'�Mi GN,•no9 .�'—:.. .`
City:�(i(t
Zip Code: .134CR7 Fax: '17a-a8(D-'04&
Phone No. 717a,oQ8i!D-CLJiscl
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: CX'YTTIi l S e CS ICa S C
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State or County LicenseU LR3�
it value at construction is 52S0a or more, a RECORDED Notice at Commencement is required.
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SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable -
Name:
' MORTGAGE COMPANY: _ 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
KUIII rINI ll1-Ayffg1 Wdf N01its IIsr!&Mellto►1rel{w-yell
as Agent for Owner
STATE OF ORIDASTATE OF mdy'A-1 FLORIDA
COUNTY
COUNTY OF MQr41
n
The forgoing instru ent was acknowledged before me
this l0 day of n was �rJ . 20j5 by
Name of person king statement
Personally Know V OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu ' -State of Florida )
Ie7_194
ev.
The forgoing instrument was acknowledged before me
thisAe—dayofR2LIINACy14 20L by
Name of pemaking statement
rso
Personally Known OR Produced Identification
Type of Identification
Produced
1/�J
(Signature of Nbgry Public -State of Florida )
Commission
PERVISOR I PLANS
EW REVIEW I REVIEW
KELLY
State of Florida
i FF 929255
REVIEW I REVIEW I REVIEW