HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! l? /�b Permit Number: 1 Inq o
CINE
APR 15 2016
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Building Permit Applieaticn PERIVI►TTiNG
Planning and Development Services St.Lucie County,-FL
Building and Code Regulgtion Division /
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential yyy
PERMIT APPLICATION FOR:
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- -tea-- ,.�.� �--�-�. = ���� _._•-� .. _...��--�.� �=. _ ._-.--.�.-_-_
Address: z6O o<. Sh2. Un h/
Legal Description:
Property Tax ID#: y3� J ��1' ODS 1 000 Lot No.
Site Plan Name: l Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mn
in-4 Lei y_c L ~
'T81156nal work to be pertormed under this permit-check all.that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ V-00 0 U Utilities: —Sewer —Septic Building Height:
TR��C�1'OR
Name o.11�r . �Zc-\ Name: t_1 S A d ll^S 0 ,N ----- --
Address: 19/vg. Company: Aali.IS0-1\
City: F1 . State: Address: 176 1 S S
Zip Code: 9A'cIL1 'Fax: City: f7. o'er,_-� State:
Phone No. Zip Code: 3Lir-19 -7 Fax:
E-Mail: Phone Nq( ?72) 0 1- 3d`13
Fill in fee simple Title Holder 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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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.
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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
Commencingwork or recordingour Notice of Commencement.
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Signature of Owner/Agent/ ee/Contractor . Signature of Contractor/License Hold
STATE OF FLORIDA o STATE OF FLORID
COUNTY OF l)e�` COUNTY-OF
The foroing instr ent was acknowledged before me The forgoing instr ent was acknowledged before me
this day of 20—LLQbythis 15---day of 20y
(Name of persoA acknowl ing) (Name of person cknowled ' g)
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(Signature of Notary.Public-State of Florida-) (Signature of Notary Public-State of Florida )
Personally Known OR Produc d d Personally Known OR Produced identification
Type of Identification KAREN S. NIELSEN Type of Identification
�`` *a�oLB�C�i
Produced . Commission N FF 115637 Produced
=° = " KAREN S. NIEL --
o� My Commission Expires
Commission No. -„ 12, 201 8 Commission No. '- egrfRmmission It FF 1 5 37
y Commission E pl s
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION . SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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RECEIVED
DATE
CO M P LETED
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