HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 �L J�J� IJcO
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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:
OEM, CATION X
,vim-sas avHFre. e�,W,» �.w,a'a .�v.:we ,3s:: infra - _ska awre ;°-
Address: W 75-0 /y/® ,0 c AJ
Legal Description: v& 43L it
Property Tax ID#: * `26llilllil� :7 7,D Z i9®-5_4 000 9 Lot No.
Site Plan Name: Block No.
Project Name: , rely , GG
Setbacks Front Back: Right Side: Left Side:
�DETAILED�DESCRIPTION F WORK ,� �,g,� � � , � _
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P M D d,/e D n4 YES,^ys r-1' eL001 , a P_t ` -e- IL/A Y P A l Y e-o eu e-!y e.Z�
CUNSTRUCTIO,N I,NF®RIttIATI®N: 4
Adclitional 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: -56 '_ Fr Sq. Ft. of First Floor:
Cost of Construction:$ 9 0 Utilities: —Sewer —Septic Building Height:
OUVNER ffll S§EE:
a, CO'NTRAGR:
Nam,e: Q,�d ei4 �- D Name EVA SS Gu 9Q,
Address: 1 DDe- AJ eil_14EX, Company: T>tcoa.- >nn >0� j:,oY1 Gr`2�R)
City:,. e .(5A I JV ,, C: E FZ• State:I1,,. Address (,015 ..Sw &SLC'Gid? C.�
Zip Code: P-/ !ff3 Fax: City:Rli-'li Sill (-t c.,'-I- State_
Phone No. 7a VIP_ l� o 2- Zip Code: V-y q b-1 Fax:
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E-Mail: I Phone No` Z.-11 -J4 U!'
Fill in fee simple Title Holder on next page( if different E-Maily:TD &,9e f08 i•Arr1,lI I T- N It!
from the Owner listed above) State or Coun ices C I UP 0 C)-+
If value of construction is 2500 or more,a RECORDED Notice of Commencement is requi ed. :,
SU;PPLEIVIENIM l CONSI"Rll1CTION LIEN 1R2VY INFORMATI®N:
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.
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
commencing work or recording our Notice of Commencement.
DLY)P,-90 rvkl_') L� f
Signa re of Owner/Lessee/Contr,actor;asyAgent for_ Sign ture of(C•carr ra'cto/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFA COUNTY OF—S:r U_,_c,9_S
The forgoing instr ment was acknowledged before me The forgoing instr ment was acknowledged before me
thisllay of u 20 by this nay
of �V-,Q_. 20—)—Y by
J ova �. �►c sse�� s���� 'e J�e\fCkS JY
(Name of person acknowledging) (Name of person acknowledging)
f
(Signature of ary Public- tate o F orida ) (Signature of N ry Pub ic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification_
Type of Ide tification Type of Identification _
Produced 1' _1 L — Fmk Produced ® 6 — Kayla Frank
�^ NOTARY PUBLI .�� NOTARY PUBLIC
Commission No.f�q .��1 STATE OFFLO IpA c/I
Comrrt#FF9228 7 ommission No.� ?i20 I STATE OFFLORI
Comm#FF922817
ExplreS 9/30 019 " res 9/30/20 9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW_ REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.