HomeMy WebLinkAboutBuilding Permit Application Fax: +1(772)4621678 Page 3 of 6 06102016 9,.07 AM
From:Nicole McMahon Fax;(772)621-5959
ALL A i Pi.ICA 1. t F9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number- l Vl ote
Building Permit Application
-
ej
RECEIVED
PlannL and Development Services . JUN / 1 2016
Budding and Code Regulation DIvislon
2300 V�rglnla Avenue,Fort Pierce FL 34982
Phone�1(772)462-1553 Fax; (772)452-1578 Commercial Residential-L.1�
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPJ6 I-N EMtN:rob
f v--n-
Addressl q r cLcce, T 1-
Legal Description-
-9
Property Tax ID aw Mle 7 Lot No.
site Plan Name: Block No.
Project N arne.
Setbac s Front Sack: Right Side: Left Side;
DETAILED PE-SCRI-P-TI 0-- N 0FW0R-K*.;--,---':'-
7 0)
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AddItIonalwaflitob0Gas
rformecs unclerthis permit-c heck all that apply:
LLj<AjC Tank 7Gas Piping F_Shutters ❑Windows/Doors
5166trIc Plumbing 7Sprinklers 1:1 Generator Roof
Total Sq, of Construction- Sa.Ft.of First-Floor:
'4 pq,U- OC) Septic Building"eight'.
Cost of Construction.$ Utilities:[:]Sewer F
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NIT
OWNE.,
Name I Nam
Addre
City' 1 aii
State:k, Address, 0 V)kk)i le
Fax 'I I)/-:,
Zip Cni,I City: — "AL, StateA—'L
N -q - 71AC -ua(ee-*�
Phone 4a?�G-3 N27 Zip Code,q, AQ 4 Fax:1
Phone No.
Fill in fee silmpleTitle Holder on next page If different E-Mail:nmcmah4675, C
from the Ow� ner listed above) Stateor County License:c R
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
From:Nicole McMahon Fax:(772)621-5959 To: Fax: +1(772)4621578 Page 4 of 5 06/0212016 9:07 AM
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: �Not Applicable
Name` I Name:
Address: Address:
City: I State: City: _State:
Zip: 1 Phone: Zip: Phone:
I
FEE SIMPLE TITLEHOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: I Name:
Address; Address:
City: I City:
Zip: i Phone' Zip Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lurie County makes no representation that Is granting•appermit will authorize the permit holder to build the subject structure
which.is ln:conflictwith 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,l do hereby agree that I will,In all respects,perform the work
In accordance with the approved pians,the Florida Building Codes and St.Lucie County Amendments.
The foliowlIpg building permit applications are exempt from undergoing a full concurrency review:room additions,
accessorystructures,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 a first ins ectaon.If you intend to obtain financing,consul ef3 n attorney before
co ends r or recor i or Notice of Commencem
_ -S
�`Signatu�el of Owner)LesseeJAgent �, Signature:of Contr or/dcense Holder
STATE OF;FLORIDA .r �. STATE OF K ±u S� z•
COUNTY OFSi�� IIS a COUNTY OF rM-� CD
jg=The fo oing-instrpment was acknowledged before n The fo going-in n nt was acknowledged before 2
this•o day of civ��- 20!\—Ay this day of. SZ 20}�by §* a
1 Q �
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{Name f pe11rson acknowled 'ng} (Name of rson acknowledging)
{Signature of Notary Public-State of Florida} (A'ir�atu`re of N iary Public State of Florida} ' •y .�
r �-
Personally KnownO.R Produced identification Personally Knowny OR Produced Identification
Type of Identification/Produced Type of Identification Produced
CommissionlNo.r--L: (Seal) Commission No. W7 5- r-7 (Seal)
I
Revised 0 J15J2014
REVIEWS I FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE I
INITIALS
I
From:Nicole McMahon Fax:(772)621-5959 To: Fax: +1 (772)4621678 Page 5 of 5 0610=016 9:07 AM
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Rated irq'41ows 0460 1., :anO.,Aj'r�'.Sojurce
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