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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f� �( Date: Permit Number: f RECEIVED Building Permit Application 0: Planning and Development Services AUG 2 8 2617 Building and Code Regulation Division PERNiITTI(`! 2300 Virginia Avenue,Fort Pierce FL 34982f. Lucie County"FL Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residentiais PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line J PROPOSED_ IMPROVEMENT LOCATION: Address: !9Di_�I L) 5 Poch- si-bcier Legal Description: 341 Y` — '; — 1 SO 9 —�31 o —c � l Property Tax ID#: S©t -18�S 9 Lot No. Site Plan Name: int INN G1 aouf 56y MQ1E Block No. 2- Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: ROOD «%f_ Ch Av3C_00+ CONSTRUCTION INFORMATION: Additional work to be er1ormed under this permit-check all appy: _ I/NHVAC Gas Tank ❑ QGas Piping _Shutters Windows/Doors Electric 0 Plumbing Sprinklers ElGenerator E]Roof Roof pitch Total Sq.Ft of Construction: SFt.of First Floor: Cost of Construction:$ l Utilities"nSewer E]Septic Building Height: —t ,"OWNER/LESSEE: CONTRACTOR: Name NAPo I I WA-10 flOARiDA EAS w4sk OW44f Name: NG Address: ISS( /LtJ Inn�rj • Company: ASS OCi ECll�l�CP, oN>bV-k51L City: ( RC�O CA VJ State: Address: 1 Sq)- 5C- I rn 1 .C(VQ_ Zip Code: Fax: City: iV::k51 L"i6i" State: f L Phone No. q6-!d000 Zip Code: 3N!S Z Fax: x7 i 33S—�So$ E-Mail: Phone No. ,. -772-- '33S-70303 Fill in fee simple Title Holder on next page(if different E-Mail: 1 i)550C i AlEb (3F,ll5dc3•Y1-AI from the Owner listed above) State or County License: Ct�Ct��-162 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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.— L/n 1.4 . P vl��]k �� ! Signature of Owner L ssee ontractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIPIN STATE OF FLORIDA COUNTY OFA . L AIf_ COUNTY OF _57- L UC/—,—r'- The for_oing instru ent was acknowledg d before me The forgoing instrument was acknowledged before me this day of 20K by this day off UG LLS l 20/7 by Name of person making statement Name of persgrl making statement Personally Known OR Produced Identification Personally Known ✓✓ OR Produced Identification Type of Identification Type of Identification Produced Produced I (Signature of Notary Public-St to of F orida Si nature of Notary Public-State ( 'aa' ITT *' *1 MY COMMISSION# 9209 ,,;;"" AREN S. NIELSEN p .`moi pt IU I (�� �o, Commission No�j �� •��Se l ission No.�F�aTc�B 'Macs' ,+,e PIRSSJanuary 2019 v *? mmission N FF 11 (fon My Commission Ex fires (407)398-0153 FloridallotaryServi m "F1.00 June 12, 201 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17