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HomeMy WebLinkAboutScan 2017-11-14 08.05.29ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application :Tanning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce Ft 34982 Phone: (772) 462-1553 Fax. (7 72) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: 1�l�C7�1 Cs) Legal Description: DCe 4-a IT; ;_ I iGL ,� � i t/ c � a 3 T7 Property Tax Iia #: _ d l--ScIA- (23 --0 Lot No._ Site Plan Name: Block No. Project Name: Setbacks Front Back Dight Side Left Side: DETAILED DESCRIPTION OF WORK: r ) CJ Cti�{�r, 01!`y�'j' �u! �]-✓� � IGf��1.'`l (�C�i� r CONSTRUCTION INFORMATION: ION. Additional work to be Pertormed under this permit -check all tho appy. HVAC Gas Tank Gas Piping _ Shutters Windows/Doors Electric © Plumbing Sprinklers 1:1 Generator FIRoof Roof pitch Total Sq. Ft of Construction: Cost of Constru,Lion. 0 L>> 5 Ft. of First Floor: _ Utilities: Dseptic Building Height: OWNEROSSEE: CONTRACTOR: Name 'y-� Address:- ddress: ^g ,- r . c Name: Company- "f i� �C� �^ � fJ�j a City: City' / 5 +.k� ..—.._—_-�.�. Zip Code: '';41gGi Fax: Phone No, �f �4� � � "'v 7rr7., L./ �.% fir- State f'u !-Z 1A Address:4-441 j Address: 4- 4I City: = i - Zip Code: Fax.: Phone No. 1 - -79L 1 C, - Stater Cl .5. E -Mail: Fill in fee simple Title Bolder on next page ( if different from the Owner listed above) - E -Mail: State or County License: it vaiue ar consirucuon is �tt5uu or more, a KF-LUXULU 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 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 5t. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, wails, 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 rnmrnencing work or recordine your Notice of Commencement. Rev. 8/2/17 Signatur O r/ Les ctor as Agent for O r f Contra License Holder -- - STATE OF FLORIDA STATE OF FLORIDA COUNTYOF COUNTYOF ' The forgoing instrument was knowledged before me The forgoing instrument was acknowledged before me this I L4:�'day of ft. 20i by this ) 40�ay of — 20 jJfby }/._)U1,_ Name of person making statement Name of person making statement Personally Known ,l' OR Produced Identification Personally Known ice` OR Produced Identification Type of Identification Type of Identification Produced Produced (Si tore of Notary publir� _&_ J rL,:,A nature of Notary PUbli - `11{11111!!1 i .Q'. "°�a,'•. JAS M AULERSON Commission No. °4 t'' ++IFRY p11j > �` Uee; ; JA Ml AULERSON Commission No. _ ` " N�uy P� State at Fiarida _ � Notary �l i ,State of Florida Commiaslnn # FF 865546 %i Commission # FF 965546 �.,+�, r• My Comm. Expires Feb 29, 2020 MY My Comm, Expires Feb 28, 2020 REVIEWS MR FRONT wF11PNs1rN"PMW ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Budding 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: --A- "L L.A-X Y% f'z-t '�57 % --CIAJ Legal Description: Oc e6` V-' rP �,) eis . ;Z � '�(- 7 Property Tax ID#: g -.ter — ()1.x`1 LotNo- SitePlan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional war to e e orme under this permit -• check all that appy: HVAC Gas Tank DGas Piping _ Shutters Q Windows/Doors ElQf1ectric ElPlumbing 05prinklers Generator u Root Roofpitch Total Sq. Ft of Construction: Cost of Construction: $ <_" C) 00, S Ft. of First Floor: _ Utilities: —Sewer 0Septic Building Height- OWNER/LESSEE: CONTRACTOR: Name <'e 4.44 Name: s. Address: `�l FL';� 11 .'� r1_ ItU _ Company: Address;r S� � City: Lv�s 1��t. State:_ Zip Code: ,_; iA o- Fax: /u (A p Phone No. ( - t7 26 2 City: - � � [� Zip Cutler - &6 a- Fax: Phone No- E -Mail: 4P 4: State r E -Mail: a t..w; + C' Fill in fee simple Title Halder on ext page ( if different from the Owner listed alcove) State or County License: 26- . F I If Value of conAruction i5 $2500 or more, a RECORDED Notice of Commencement is required. ENTAL CONSTRUCTION LIEN LAW INFORMATION: FDESIGN/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Marne: Name: Address: Address: this of �fi�uf1 City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do ine work anu IIIS1dII6U0F1 Cla 19IGlSbif=�. 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 praying 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 ....1.of f nmmonr.,=mnnt. 4U 11n11C1I1..111r, vvul li ve �c1.vi.w aFP v.w� :....,..,.. ...-..-�.. ....._..__-------- Signature of Owner toontractor as Agent for Owner Signature of CHOldef s' STATE LORIDA STA LORIDA COUNTY OF :J-- LAC_L' _ COUNTY OF The forgoing instrument was acknowledged before me ,+� The forgoing instrument was acknowledgbefore me day r Zii 1 this day of �� — . '`, 20 1 i by this of �fi�uf1 Rby {{, ��/ Dame of perso making statement Personally Known OR Produced Identification Blame of Persgn making statement Personally Knowtn;i" OR Produced Identification Type of Identification Type of Identification Produced Produced ( nature of Notary t of to ida) (Si tore of Notary Public- State of Florida) Commission No.No.Co .,, JA ON M RAULI_R5©U01N a re :i ': JAS cy"1 UL, SON commission {�©. °�' r Pu NDtYpiic - Slate of Horida ' Notary Public - State of Florida *° iy co "Mission # FF 965545 Commission # FF 965546 Corti •,,,c j � ••7 My Comm. Ex fres Feb 28. 2020 REVIEWS FROM -fiI`hVIR' PLANS VEGETATION SEATURTLE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17