HomeMy WebLinkAboutBULDING PERMIT APPLICATION� I - -_ qw
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C\N W SCANtVIED Permit Number: N4'6'A— dza 13
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0M M-Mmowm- W= - ie County
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Building Permit Appi
Planning and Development Services
Building and Code Regulation Division
2300 VirginiaAvenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: (
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Address:
59T 17
SEP 12 2018
ST. Lucie County, Permitting
Residential
Legal. Descriptir r0JPcAI)R?S L4,�A(- LA-�_L I 'r )3 1 6�& 3 69 5_6 —3 5_
Property Tax ID #: M14 LeO W5q — OA�22 - IT Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
—Mechanical Gas Tank —Gas Piping Shutters
— Electric — Plumbing Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Utilities: Sewe r _ Septic
Block No.
—Windows/Doors
Roof Pitch
Building Height:
VOW R E :RT/, 00-S—S E
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Name r-- -/_ o
Name: Sy-fonLL 44--14,5
Address:-4'1 'k K k(A
Comoanv: H4LIK CZWIM��( o,*,( G,'FAXF
City: Pr. State: PL,_
Zip Code: Liq _X:
Phone No. U 4
Address:
city:-I)mo 9_9A('H S. tate:
Zip code: 22 Fax:
PhoneNo :2-?? 651m-)
E-Mail:
Fill in fee simple Title Holder on next page if different-,
from the Owner listed above)
E-Mail CA
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State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN ER/ENGI NEER: Not Applicable
MOkYGAGE COMPANY: Not'Applicable
Name: T-F, i5wt-171 (Qw:� 10 "'t.
Name:
Address: 11� 11
:Address:
City: XXib �- L
City: State:
Zip: Z'4A 4 o ' Phone__27 2- 9 T�r
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: —Not Applicable
Name:
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 that
or and covenants 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 t6 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 sted on the jobsite
before the first *psiae�tio - If you intend to obtain financing, consult with leno_� o7n attorney before
commencingo-ork or/r7cc rding your Notice of Commencement.
42WI
ignat r 0 Z bs�ee/cdhtractor as Agent for Owner
=OFLORRDA
'Signature otl2i�il cerise Holder
STATE
k.
STATE OF FLORIDA
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COUNTY 01
COUNTYOF
The forgoing instry;nent was acknowledg?l before me
Q- =1
The forgoing instrument was acknowleclg��before me
Sf,�
this N day of -9- RA 20jnL by
this_%'n�,clayof \- 20_W by
2,c--,o,, kAMe,5
1�1 f � C1 V"_ \A"nk-i'k S -
Name of person making statement.,
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identi ation
Type of Identifi?tn,)
Prod
Produced
(Signature of Notary PVbli (Signature of N St
Ic- n4 MEYmO'22*1023
g
C ISSION #
6,2020 11 RES'DMM F18,2020
Commission No. s. Demm Itommission No. A
onded NIMIV
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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