HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 10 ° 19) . 201LP' � Permit Number: 0_ � O�
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Building Permit Application
Planning and Development Services OCT 18 1096
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: To Select from dropbox, click arrow at the end of line
PROF'(JSED IMP.ROUEMENT LOCATION
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Address: —1104 MAID STOOD DPW6
Legal Description: M A iV S1-00i (pp, '{:�' I 1 LOT qct (09 3(02-00 ));3-7 i3- IS4)
Property Tax ID#: 232,2- 666 01 0 b OW 5 Lot No. q C1
Site Plan Name: MA tJ Block No.
Project Name: V-7(,1A'y (\A A(Q
Setbacks Front Back: 91 A- Right Side: Left Side:
DETAILED DESCRIPTION O WORK '" # '
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I N STKIW N C-W -41 C U N11 T 1 NIS I De -t- OVTSCDG N0 'Dt rT W 0 P-1--
RGPLACG EX151-1NG UN 1-C 4.e4z, / 0 &L%1 1X7-0 A/
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COISUCTION "Xi,
Addition
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A ition workto ->be eorme under this permit-check a apply:
XHVAC Gas Tank Das Piping _Shutters Cl Windows/Doors
Electric ❑ Plumbing ❑Sprinklers 1-1 Generator El Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: J
Cost of Construction: $ 21 00 o OO Utilities: _Sewer _ eptic Building Height:T
OWNER/LfSSEEr ` rtr
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Name Q0WST/0,WCG-r N ORINY43 P( AY MAN Name: JPrSpN D I F MpLQ 1D
Address: -7104 MA i0S;M WC- -DTZ company: 91 (}MOND A. Co UC
City: 'ITT SIT LIAC1E State: 1=L Address: M45 SW Q460 C le
Zip Code: 3 �(0 vv Fax: City: SN %2:TState: TU
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Phone No. 82-0" t5DO -035 Zip Code: 3499- _ Fax:
E-Mail: Phone No. -1-12 3(o f - 5593
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:—AG 4 81-7 3010
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPR,LEMENTAL COIVSTR= CTIONG,LIENLAW: IN�QRMATION (
of 1.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:_
FEE SIMPLE TITLE HOLDER: _ of Applicable BONDING COMPANY: of 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. LucieCounty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is C 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 an 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.
LJ 1.'W''44V &J.
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Sighfiture of 0 er/Lessee/Contractor as Agent for Owner Si ature of_C(fritractor/Lice'nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST we Ic- COUNTY OF ST Lu 1
The forgoing instrument was acknowledged before me The forgoing instrument was acl:nowledged before me
this day of Q=J 20 Jkby thisff day of ( 20 Ka by
�Gsow Diam- onck JQS6n -DiQwQaf
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Publi -State of Florida ) (Signature of Notary Public- to:e of Florida)
Personally Known v' OR Produced Identification Personally Known ✓/ OR Produced denti ication
Type of Identification Produced_,,. Type of Identification Produced_ S D
Commission No. sion No. �13 Seal
NICHOLE AP NTE �..... WCHOLE APONTE
e•: .•� iismom 9 F963031
Revised.07/15/2014EXPIRES May 04,2020 -N. EXPIRES May 04,20 0
NCtr9le•C'!7 RluldaMala � �iCA3!*C'0.i ILrtbNara SaMw.wm
REVIEWS. FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
LINITIALS