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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: jw,7r,� l��ti ,,, ti zp�� �;d`��ik�€ e";s ���,\�,✓Gi �:i _...,��} i JUL 12 201' " BuildingPermit Application �., pp la���i, ,�,l Planning and Development Services St. Lucie C:ounby, F! Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential >C PERMIT APPLICATION FOR: Uma PROP®SED IN:' RSQ�/E�MENT L®CATIO:N nn Address: ��a\ &o©haR_ �-�dcw Legal Description: Property Tax ID#: q V "1 �' Q� '� Lot No.� Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DTI I. # WHO $I PTI O �; a,ig �" S41csc_ue� Cfmo1csu, t)e. uL Dob S N L \- S CONS RUCTULKNRNR FORD ANTAII Additional work to be performed under this permit—check all that appy: _Mechanical _Gas Tank` _Gas Piping _Shutters _Windows/Doors _Electric Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction:, Sq. Ft.of First Floor: Cost of Construction; Utilities: —Sewer _Septic Building Height: Q1NrNER E-0-SERC0 TR `f0'R: Name ?r6a a o -o¢,�'� Name: UM hXA Address: Company: c �e City: n1 ►ePlse State: Address: a Zip Code: aLkn?- Fax: City:�Coy -Acuff Stater Phone No. Zip Code: 3-{CLS Fax: E-Mail: Phone No 77c) — 'u'78- 3qW5 Fill in fee simple Title Holder on next page(if different E-Mail �* P115vgA—) q)"w(:4 O W )VS from the Owner listed above) State or County Licensee'—,V7C &'7S`� if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU�PP:LEM�E�N�'�L CONSTRl1CT'1®M LPE�N LAIN 1'�N�FtJRMAT'1®N�: f 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 commencin work or recording our Notice of Commencement. Sign ture of owner] essee/Contractor as Agent for Owner Signaturof Contractor ense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTYOF_ k� �, COUNTY OF nk I The forgoing instrumerit was acknowledged before me The forgoing instr ment was acknowledged before me this-4, day of (I 20-ff by this day of 201'1 by LW (Namof per on a nowledging) (Nam of person a no dging) 1011'.AA (Signature ofNotary Public-State of Florida) / (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification aj Type of Identification Type of Identification ProducedQ�, (�Y� m� roduced KAREN S. NIELSEN \,\4PAY Pus,, AREN S. NIELSEN - ( 8a1),;scion 4 FF 1 1 563 mmISSIOn NO. ' /� Co mi en # FF 115637 Commission No. �l � - \r.e My Commission Expires ,, }ij ,rr M mission Expires f£ Juno 1, 2, 201 8 ' June 12, 2018 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.