HomeMy WebLinkAboutBuilding Permit Application J
ALL APPU�,,,MLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ,1 l-a3-c;LS
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RECE14'rD JAN 13 7017
Building Permit Application
Planning a d Development Services
Building aId Code Regulation Division
2300 Virg"iiia Avenue,Fort Pierce FL 34982
Phone:(7 2)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ,�-
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(.Q I O'S (�!h � V,Add dress:
Legal Description:T.L+ t7s�akC-s Z $11< I l L. K 2
Property Tal ID#: (00 3 Col b(0 - ClpL.j S_ Lot No. �2
Site Plan Name: Block No. !f
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Project NaTe:
e:
Setbacks iFront Back: Right Side: Left Side:
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1t1ona �nror to e e Orme un er this permit=c ec a appy:
HVA Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers E Generator Roof
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Total Sq. Ftlpf Construction: S Ft.of First Floor:
Cost of Construction:$ 7-1c) if 214Utilities Sewer Septic Building Height:
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Name Jc��:�.� Sw-:� Name: PeterACafaroIII
Address:. Je!o 't� Qp.' Company: Lowe's Home Centers, LLC
City- l7 i&Ad-* State: rG Address: P.O. Box 781993
Zip Code: II 3 h 4 e 3C Fax: `` City: Odadno State:FL
Phone No-177-17, Zip Code: 32878-1993 Fax:
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E-Mail: ! Phone No. pz_ 4161-3(;09
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Fill in fee simple Title Holder on next page(if different E-Mail: 'TP G�L VAhoo. eom�
from the Owner listed above) State or County License: CGC1508417
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If value of co struction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW IN,FORMATICIM :
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: AkNot Applicable 1
Name: Name: j
Address: Address:
City: State: City: State: i
Zip: Phone: Zip: Phone: f
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FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable j
Name: Name:
Address: Address:
City: City: I
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 thepermit 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 propert . A Notice of Commencement must be recorded and posted on the jobsite
before the first inspec ' yo intend to obtain financing, consult with lender o orney before
commencing wor recordi Notice of Commencement.
Signature of / ent/Les e' Signature o Contra r/ rise Hol
STATE OF FLORI STATE OF FLORI A
COUNTY OF src COUNTY OF SLC
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The foreoing instrummee was 4cknowled ed before me The fnraoing instrum-Pnt was acknowledge ore me
j this '►..day of Jic►.� 20 y i this/�&ay of _ 20 y j
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IPeter Cafaro 111 Peter Ca`aroIII
j (Name of p so ackno ging) - (Name of person ac --n
(Signature of Notary Public-State of Florida) (Signature of otary Public-State of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
i Type of Identification Produced Type of Identification Produced i
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I� Commission No. (SeethCH 8000OK Commission No. D
Notary Public-Stale of Florida y`• = Notary Pua CDmmes Marl-e^@20.8
Commission t EE 176869CommisRevised 07/1-9/20 "� "" Bondeo Throuoh N;lionalNotary AssnBonded Tbrousn,
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REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE `
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW I
DATE � I
RECEIVED
DATE I
COMPLETED