HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR-APPLICATION TO BE ACCEPTED
Date: �} a� i� Permit Number: W(31-035(3
^ . RECEIVED A" 02 2016
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: ���_ �� ` � �
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PROPOSED�INPROVEMENT LOCATION . "
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Address: 2 -71( N - 'AIA Lluhi rt 6- IT -Fcena,'-� nL- `.>4 61"I "i
Legal Description: (_°eNaAL am,-:r eC-.—aca 5cc-7aL!yQ ah-),E &3 W. = `7
Property Tax ID#: Uk„y�X111 01k:7 210V 0 Lot No.
Site Plan Name: QHS Block No.
Project Name: fNi� 9AC-e491U
Setbacks Front Back: Right Side: Left Side:
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�CONST4RlJECT10`N{INFORMP►TION � : � ��' 7
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Additional work to be pertormed under this permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing —Sprinklers _Generator Roof
Total Sq. Ft of Construction: 30V Sq. Ft. of First Floor:
Cost of Construction: $� 7 2L_ Utilities: —Sewer _Septic Building Height:
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01NNER/LESSEE mayga. : L i ,
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Name i3 1�.AQl s Name: 5--c-k,)
Address:a"1 I( h. , A(.A Lli] if -6 Company: 0,kSiotZ&LLA4 0:7Vi i(.cL4- LU"
City: f-iPri^=y,'�L.� Stater Address: :7 ' 1 of:.i rz *f45
Zip Code: 3gq'4e! Fax: City: i-i- State: �2
Phone No.1-1:2- Z9 a'D5 Zip Code:5ka1 ?s Fax: "772, •C- +/tF,)'�
E-Mail: Phone No -')`7T 21,& -&V:7
Fill in fee simple Title Holder on next page ( if different E-Mail V.-
from the Owner listed above) State or County License `CO7�"�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S,UPP,c MIENTALMINSI R-UCTIO�N�IEN LAV1/ IN.F= RI�/IATI®N,
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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�ecorlfingl
y. A Notice of Commencement must be recorded and posted on the jobsite
before the first i u intend to obtain financing, consult with lender attorney before
commenci orour Notice of Commencement.
Signature of O essee/Contractor as Agent for Owner Signature of ontractor Li e
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OF - L_O c "Z, COUNTY OF S A-•
Thefprgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Qy� 20% by this 8- day of 'Z5�'62 20�QS by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub ic-State of Florida ) (Signature of Notary blic-State of Florida)
Personally Knowa�_OR Produced IdenW.ic ''���N�cJ�F�O\�ao bP. rsonally Known--*-\' OR Produced Identific t�ign
mew SPH`' ,cel b. r?\V� \0 —
Type of Identification p ° pec 16 Type of Identification p Np to of o
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ProducedsFflduced
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Pia , \ss`0° a�\°�a\N pss°-
Commission No. �� �0>1 *n .{� a�omm °��rN Commission NO. �si°a\N°�
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