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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABL NFO)MUSTIBE COMPLETED FOR APPLICATION TO BE ACCEPTED Date.`v7 Permit Number: I F % ::gar J M 5 Building Permit Applica'ti'on 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 X PERMIT APPLICATION FOR: MEMO LNPROUEMENT LOC`A/TION: ��jj Address: i 1yZT NE: ItLF-S Q L Y b J-4NYE /1 SCA /bi F_1_+ ; � Legal Description: &E-fi g ls4 xib INC.- A 06100 Sacf na3r pOAACP_ Ila* s4 Cti-0 P I�hf, 3 Rel 1 /� Property Tax ID #: `�11_ 0c;_62 _ky/_ (9 0-1 I Lot Noll )44 Site Plan Name: .I Block No. Project Name: I' Setbacks Front Back: Right Side: Left Side: i9 D ALD ►f�S ` IP ON ® V�/ORk: &r_=11111 ®14E ,.'A a.A10l1_ES i fV NAM £ b A AEA o f R )OP'. ION i/,p,0g�psS AkrA (yF` AC)Z) -th Ao* lRb MD.SrEc iii t'aN ' U/� NJ5 A4AeI . �3l? @ONSTRU TION NFOR TI©N: I' .I itiona wor to a pe orme un er t is permit - c ec a tat appy: Mechanical--'.- _ Gas Tank _ Gas Piping Shutters J _ Windows/Doors Electric _ Plumbing _ Sprinklers , _ Generator X Roof Pitch ' qI Total Sq. Ft of Construction: %P%�iel�3� o�'�` Sq. Ft. of First Floor: Cost of Construction: $T Utilities: _ Sewer _ Septic Building Height: 0 N R/L SASE I: CONT ACTO . Name 1- Ai N a t✓ f4F_Roi' TO Name: �' e f L- Address: --�_% /pfqSL RA Company: vjoi�r /Q .El-AA0 A OZAK City 3 0IV 6 State:/JA 'Address: 1pw `le %�;Xi£ NA UlAy Zip Code: �%%(% d� Fax: IIIA City: HeA£ Se Ii'VA I State: F/_ d Phone No.q/ 3- S%2 ` / (7 vG G Zip Code: 3SS J J5 Fax: �77:2-A,-)3-66 8g E-Mail: Phone No Fill in fee simple Title Holder on next page ( if different E-Mail Toa S (JE,E_,©0 AretlMAI) . a C-01A from the Owner listed above) State 9PC-4twAy License CCC 13:17 6-3/ I� If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INF®RMATION: DESIGNER/ENGINEER: _ Not Applicable Name: /l/A MORTGAGECOMPANY:' _ Not Applicable Name:_ Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: &AL BONDING COMPANY: Not Applicable Name: AVA 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 rommencing work or recordine vour Notice of Commencement. Rev. 7/2014 Signature of Owner/ Lessee/Contractor as Ag&tor Owner Signature of Contractor/License Holder STATE OF FLORIDA t &�—Lct- STATE OF FLORIDA COUNTY OF COUNTY OF J L The f pr going instrum t was ackn wledge before me this day of 20� The fo p�e+mng instru ent was acknowledgedbefore me this ��Qlay of 20yy P�CC-4c-112— (Name of person acknowledging ) (Name of person acknowledging) C��) 17 k (Si re of o ublic- State of Florida) (Signature of Nota ublic- State of Florida ) �� Pers nally — OR1Ri�i` JA8IlYlc�� tif�a'ion a ersonailtj�lC 65�fIT AfORLlartidiu Vd Iden fication o[ar Public PgYl T e t i fa Notary Public - state of Flon #� FF 234730 o y - State of Florida a a # F 4 �,; F 234730 Produced =•t; » •= commission r` 1 2019 My Comm. y 27 l P�odtaced:�_+ = •Commission •} v 1 I xpires May 27, 0 �i �� i f f,, rdcd ;hrougli rlational ^lntary Assn. 4j Commission No. Seal - ( ) _ 1` Bong d through National Notary As'hfj a 1) Commission No >•-., �,� - _� _ �T4 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW _ REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014