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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O L 9 Date: Permit Number: RECEIVED FEB 21 2017 Building Permit Application PERMITTING Planning and Development Services St. Lucie County, FL 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: PRQP®SED IN,PRDUEMENT IOCATIC?N: Address: 13 08 PAS k L P►►1r,4 I? V0 Legal Description: (,i10-2r 0ACQ XAckT C6n13 197S TA,-rtS — hdr 2 i?C zf Lcu `to W Y2 by I.-r (Y 60 -SG Ar- 2L?fl 7SId v' Property Tax ID#: 3 6109 10 3 ^ Oo 3G cav 3 Lot No. 15 Site Plan Name: Block No._Ll _ Project Name: Setbacks Front Back: Right Side: Left Side: 11.9,11100111ED DE3SWRtPTI©N OF WOR+ �Y\S"TA4L G Fr L✓c,o0 Fanc2 -alA T nr'JpM'dRrtY COIVa TRLI.CTIQN I�NFOI�MAThON: itiona wor to a pe orme under tis permit—check all that appy: _Mechanical _Gas Tank -Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ !�Gyvr Utilities: —Sewer —Septic Building Height: MNL: LLE�SSEE: CONTRACTOR: Name Name: agke% 0 F ArlCasra Address: 13 o5S �i9r.k ��t�✓ RCompany:7ju�^ Di iw�.�?1�a Cotisv 1h City: F T' Piz WC A. _. c" State: 1Cln Address: Lf 1 f Z -CA n S a-t 8 G Zip Code: 3 u/T'6_ Fax: City: [=T ply?i,e 2 State: (^CA Phone No. Zip Code: c!9 Fax: I'l 1. kds 7.a 64 E-Mail: Phone No '7 1 2 — l S 3 9 Gd Fill in fee simple Title Holder on next page (if different E-Mail �— from the Owner listed above) State or County License C R C 1 317 l d If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CON�Sl'RtUCT'ION LIEN LAW I'NF®RMATI®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. Sign re of Owner/Lessee/Agent Signat of Contractor/License Holder STATE OF FLORIDA STA E OF FLORIDA COUNTY OF ��)(!,�d COUNTY OF The forgoing instr t was acknowledged before me The forgoing instrument was acknowledged before me this day of 201 V1 by this. day of 201�7 by ( e of person ac nowledging) (Nahi4 of person acknowledging) A 44 (Sign ture of Notary Public-State of Florida) (Signature of04-Notary Public-State of Florida) Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification +✓ Type of Identification Type of Identification Produced .L --lroduced KAREN S. NIELSEN \""""". KAREN S. NIELSEN .p ar a e`�� C� ssfon # FF 1156'17 L '�°� COmrrt h H FF 1156 Commission No. ommission No. ,e I viy"L�mmission Expiros -N do My Commission Expi—, June 12, 2018 June 12, 2018 �ro REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014