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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 6 2 Permit Number: 7 �� O 0 to MMMITEM - _ 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: INIPR®1/fMENT 11 ATI09 Address: _� ( LP0 n Legal Description: Property Tax ID#: I4 a3- 00 1 3 QC g Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILS© DE=�SCRIPTI®N i r-e R)r l I �� •5 j-o� 14 (OCr�n-cr-\ f�lc S�Xz-lye 10 C®NSTUCTI®N IN'FO'RMATI®N: Additional work to be performed under this permit-check all that appy: L--Mechanical _Gas Tank _Gas Piping _Shutters- —Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of-Construction: C Sq. Ft. of First Floor: Cost of Construction: $ �J� �� J Utilities: —Sewer _Septic Building Height: OWNER/LE�-SSSS: MN T11 ®R: Name:. L ie-) Luo C GIC Address: q-1 LP 0 EN 8-"A ko!l-A- Company: CU I N( ,A�OfIS cif RO(�C(C-�r City: F+, State: 1-C- Address: 09103 C' imr—C, UarA Zip Code: -2AC149 Fax: City:'Fo(-t P 1 C-0O2- State:-F—l_ Phone No. (D-�)I - 3Sc- a81 -19 Zip Code:39-q S I Fax: <:60I S39 E-Mail: c cc)kc�r\rn , n-c)l , corn Phone No `-I -10- q4C)^ z�`1 VS Fill in fee simple Title Holder on next page(if different E-Mail CQQ1 al CSI Q)Q n'-G.i I . C ocy'1 from the Owner listed above) State or County License CIBC I '� 19 o 0 9 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Sl1.PRLE�IIENI" LC®NSTIRk,0`CTI',®N L.t��N LAW INEFCJ'RMP�TIO�: 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 WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twi improvements to your property. A Notice of Commencement must be recorded and posted on the j = before the first inspection. If you intend to obtain financing, consult with lender or an attorney befo commencing work or recording our Notice cement. o CA 55-G Signature of caner/Less 'e o tractor as Agent forne� Signature of Con ractor/Licens r iv o= 3 = STATE OF FLORI _ STATE OF FLORIDA COUNTY( _{ I COUNTY OF . N b N O S The forgoing instrument was acknowledgedefore �T The fr ring instr ment was acknowledged before this day of 20��by a_o ff Jm= this day of201�7 by (D V ` m N t, a��c y JHyRh/ LAoTi C_-,�79 )z- . (Name of person acknowledging) (Name of person acknowledging) (Signature oDItary Public-State of Flori a ) / (Signature of Not Pu lic-State of Florida Personally Known OR Produced Identification- Personally Known OR Produced Identification Type of ldentifqatif Type of Ide ific do Produced 2- d1r. Produced • Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.