HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
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All APPLICABLE INFO MUST BE COMPLET6urOR APPLICATION TO BE ACCEPTED
Date: 4V 1 1 �1 Permit Number:
SCANNED
RECEIVED SEP 2 9'1017 BY
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: 1 of Sloe
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PSPf?S`INPRVMEfT I (]AT_ItN: '$� Rlmu
Address: AermCcI^ (` ((1u1. � yv
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Legal Description: T 1C,1.(A- D2a Y 1 �CoC �� �e-y1 ?i e EQ0-Y
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Property TaxlD �DOa-OdQ�-OOd- Lot No. ��—
Site Plan Name: C �� ( \Q✓�C� Block No.
Project Name:
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Setbacks Front Back: 0 I , Right Side: r:_ Left Side: 1 32 , %5
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'Additional be
worK to pertormedunder this permit -c ec all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 56� 5 9 Sq,, Ft. of First Floor:
Cost of Construction: L Utilities: _Sewer _Septic Building Height:
01;
Name
Name
Address:) J
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Company:..
City: ' -a State:
�Addre'ss''
City: State:_
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Zip Code: Fax � Ld
Phone Ll _i��,�
Zip Code: Fax:
E-Mail: 61) ffil � r1 t
(Phone No
Fill in fee simple Title older on next page (if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
City:
Zip:.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:_
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con, 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
m5lm�mrinv wnrk or rernrrline vour Notice of Commencement.
i
gnature of Owner/ Lessee/Contractor as Agent for Owner
Si re of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF S-r. LuLIE
STATE OF FLORIDA
COUNTY OF S.r.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisS� dayof JU'_)C. 201_"1 by
thisQL�d^ayof u,JE ,20_J]by
S Irl �k NA %A t-A
2 d C%(L 1 N r4 -Bic; 1Z-A
(Name of person acknowledging)
(Name of person acknowledging )
(Signa re of Nota y blic- S ate of F or da)
(Signat [a r Publi - State of Flor)da )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
b2tyG2 LICENSE.
Type of Identification
Pff uced 17 J L , G r ch)TARY HER
Produced
r CliR15TOPHER J. F
YAUFI� NOTARY PUB
PUS
Commission No. Fl= i 1F2 $ 14 NOTARY PUBLIC
Z$ c c STATE OF FL
Commission No. FF 14 I `}'
STATE OF FLORI
A :, = Cemmy FF142!
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�'YCE is Expires EX fires 7/17
,Vd to
Expires
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.//ZU14