HomeMy WebLinkAboutApplication NOV/12/2015/THU 02:54 PM PAX No, P, 001
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit NumberS.
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NOV 12 2015
ing 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 X
PERMIT APPLICATION FOR: Other G CuTC& �
.PROPOS '�1` :PI�O�/�M• - -
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Address: s� t�
Legal Description:1NV,,v0�k pac')A t MA: "`Z.l,.n'1'r,��'�
Property Tax ID#: 1 0 1 Q Lot No.1 to— 4
Site Plan Name: Block No, I
Project Name:
Setbacks Frontc�s� Bacic: Right Side:S—Left Side: J .
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R�rnoue c� to1c:�_�o_o a_�_a soca
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A i lona wor to e pe crmed under Mispermit—tec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric Q Plumbing Sprinklers El Generator 11 Roof
Total Sq.Ft of Construction) b 4 s - Ft.of First Floor:, no G
Cost of construction:$ 11 J 00. Utilities:'nSewer LJ Septic Building Height:
0�lV.1V1`R S'E'E.' .��:...,.... :;, :. .;.:;•,:,,:, .
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Name Name
Address Compan
city: "UWStater Address: iJ
Zip Code �l Fax: City: y� State
Phone No. Zip Code_ ? � F R-:�_LfiJ
E-Mail: Phone No. W_ 00
Fill in fee simple Title Holder on next page(if different E-Mail: &AI
from the Owner listed abase) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
NOV/12/2015/THU 02:54 FM FAX No, P. 002
.$ P
U. P.
DESIGNER/ENGINEER: L'Not Applicable MORTGAGE COMPANY- of Applicable
Name: Name:
Address: Address:
City: State: City: State.•
Zip- Phone., Zip: Phone;
FEE SIMPLE TITLE HOLDER' _P-"kot Applicable 13ONDING COMPANY: _LI�t Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone; Zip: Phone:
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 apermit 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-fM inspection. If yoVT' tend Xo obtain financing,consult with-lender or an attorney before
conmrrencing work or reccly1flnVy4ur Nalce of Comm nceTL�
s
Signe'ture of Owner/Lessee l&gent S" nature of Contractor/Lice
Holder
PA
STATE OF FLO STATE OF FLOR
COUNTY OF
COUNTYOF
(VA
so I"
c ye
The fo�golng instrument was acknowledged before me The forgoing instrument was acknowledged before me 7;
this day of OEM 20'Wy thlsL_,?,day of QnJ PMkj&— 20 L"j:by to
CAT)
a of P n ac owledging) (Name Of c now g) iv
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4gnature of Notary Public-State of Florida)
nature of Notary Pub c-State of Florida
Qrsonally Known�OR Produced identification Personally Known iced-ld�tification
Type of Identific tio. Type of Identification Produced
RYAN LYNN COLLUPY
Commission No.. -�FF170227 Commission No. (Seal)
I j* MY COMAWOON,
4'11�i_nel EXPIRES October 21,2018
6-
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS