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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO IALIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 70 Date: �• Permit Number: r zap a f RECEIVED ap= Building Permit ApplicatiopeB 18 2017 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: PROP®5'ED INPR®VEMENT L®CATI(J'N: Address: Vk4l�09 Tj ✓� Legal Description: 9 J V67z ,%f9?2,e/ q 0 L/C 3 i q ( C,212 - 7-&70 Property Tax ID#: 7 9/ 1 IS7 3 D C116e:;) e0-r-1 - Z Lot No. Site Plan Name: Block No. Project Name: Setbacks .'. Front Back: Right Side: Left Side: �SCRJPTION OF WORK: j2 c---_ 4-o C�ONSTR+UCTIO'11111111910,81 TN: Additionalwork .to e pe Orme un er.t is permit-check all tat apply: - _Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator oof Pitch.- Total Sq. Ft of Construction 'Z Sq. Ft.of First Floor: Cost of Construction:$ 4?©0 - Utilities: —Sewer _Septic Building Height: NOM NER/A111MSEE. CONTRACTOR: Name llJ �Z- 3/d SGA Name: Address: 2'?-ZO 56- Company: 1, L City: O`lili rlT vGIG' State:_L Address/s: Zip Code:3 Ll-7 C/ Fax: City:/ioa.L Si,C State: F-(- Phone No. 6 Z L( 9- / Zip Code: � 4 c? g Fax: E-Mail: Phone No 7'7 2 2 2 4 49( I t c9 Fill in fee simple Title Holder on next page(if different E-Mail (��,y�L7S P S" � �� • . from the Owner listed above) State or County License LG G 13 Z 87 3 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUP'P'LEMENTAL C®NSTR.UCTt®N LIEN LAVV INFORMATt®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 Noticncement. ignature of 0 essee/Contrac oras Agent Signature of Contractor/License Hol er o z Tl< a Xn C STATE OF FLORI STATE OF FLORIDA P z m m COUNTY OFCOUNTY OF �N �zc The forgoing instru t was acknowledged befoThe fo oing instr ent was acknowledged before s this day of 20 /"/ by this day of 20L by o o j 8 N N 4LB�ZF® wkly 0C>_-_1 WT-D M WAI n (Name of person acknowledging) (Name of person acknowledging) (Signature of N civry Public-State of Florida ) (Signature of Notary blic-State of Florida) Personally KnOWRI OR Produced Identification Personally Known OR Produced Identification Type of Identificatio Type of Identifit�� n`C Produced 1C., Produced r.'� . Commission No. V (Seal) Commission NV (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.