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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ° 11 Permit Number: R E C E R"I SEP 0 a 2077 • 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: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: .33�3 V E—R--A W%->A N� Legal Description:341 q ` S r (�03 - -S i vi✓ _ -UY.1 I'T 43 L K Z L_cs -ss S.G, 7 Property Tax ID#: 73 1 cl s3� '-C7 CO;---,59I -�00-5 Lot No. -a>ci Site Plan Name: A Block No. Project Name: Setbacks Front ZS Back: I a Right Side: fy Left Side: DETAILED DESCRIPTION OF WORK: ��5 1��- p�-t-► o n O f� ) C> CONSTRUCTION INFORMATION: Additional work to e e orme under tis -,checkpermit a appy: HVAC f]Gas.Tank ❑Gas Piping _Shutters a Windows/Doors L1 Electric 0 []Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ I �o Ca O Utilities: Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name1�- C�t�x-1z�- N� e-- 1:::�- Name: -:SO M Address: 33--�> 'S-E, VeeR p-6 A-r C Company:nZk' '01 iv'-t-L' LLD-l;)2._S City: _S l State: C. Address: �1 l)�� Zip Code: 3 4 Fax- � � City: State: 4J Phone No. �-�� tO 31 _ �� �-- Zip Code: 'C Fax: �� E-Mail: l�� ` Phone No. '� ®Z `�-7-7 ( (o 6o Fill in fee simple Title Holder on next page(if different E-Mail: S 6 1 CA _ 0JX Gam•C from the Owner listed above) State or County License: S 3 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION IEN LAW INFORMATION.: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State:,-- City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: ' _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 fins g, consult with lender or an attorney before commencing work or recording of C encement. i Sign essee/Cont cto s Agent for Owner ig ature of Contr License Holder STATE OF FLORIDA ATE OF FL? DA COUNTY OF COUNTY OF /. �r. L The f rgoing instru ent was a knowledged before me The forgoing instrument was acknowledged before me this day of�ry uo- .20— y this day of Pte_20�I by V __ ` 'C sg. IAC Name of person making statement '/ Name of person making statement Personally:Known OR Produced Identification !/ Personally Known OR Produced Identification Type of Identification Apy , J�� Type of IdentifraL nn L Produced / ✓ Produced a (Si ure of Notary Public-Sta , � ignature of o_ta blic-State of Florida) p, ms/sy..,� Y P 6, LINA URIOL ( �1�y�-- Commission No. ��/�/7.�!Y ;� ` �a1) Commi ion - NNAMARIE((iVA _ Notary Public-State i if Florida N `- MISSION#GG 022023 =No oPc Commission#FF EXPIRES:December 16,2020 1971 '", ��= or Fro;•'' My Comm.E '' ' Bonded Th,Nota REVIEWS FRONT ZONING SUPPERS VEGETATION SEATURTLE TAROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17