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HomeMy WebLinkAboutBuilding Permit Application ///�7 2 o0 111A,? It ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: //'o2 'y/� Permit Number: 1•�` ouitaing rermn Appmamon NOV 2 9 2011 Planning and Development Serv;ces pER'O I Building and Code RegaWion VvWon St. Lucie CCL ty FL!2300WginiaAvenue,FortPierceFL3498z Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential PtKMI 1 APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line V PHOP()SED IMF'KUVI•MrNI LOCC-AIION: Address: ©/ /� 1"���' Legal Description: Property Tax ID M._ 33'7- Dl'Q���'��O"v� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Ur=lAlttU U:SCKIFI ION UI- WO KK: _r CONSTRUCTION ('�wngc o✓i /�/te�.r- CONSTRUCTION INFORMATION: ona wor o e r rme un er is perms -check a appy: VAC Gas Tank Gas Piping OGenerator ShuttersWindows�Doors ,H[]Electric LJ Plumbing Sprinklers �Roof Roof pitch Total Sq.Ft of Construction: r S Ft.of First Floor: Cost of Construction:$ ���4 Utilities:0Sewer 0 Septic Building Height OWNER/LESSEE: CONTRACTOR: Name N2n1m4.iu y S'14 d=w a""u Name: C L'1�T t S SYA(K tMG n S Address: 53 4 9 W Q Company: 6 ti13-'a m A +r S-u 5 t ems (RJ_1- city: 9�uZ oam�' y State: M:1- Address: 4 E �, I_ d -,e r eei1 0 r 8 Fax: C►ty: I e5 �t L vct e_ State: F_t-� Zip Code: "� 77 ,�35-iq �d Phone No, 313-h/lv 7-k6, Zip Code: 4K 5.2• Fax E-Mail: Phone No. `/1dL a-35_ 31) � Fill in fee simple Title Holder on next page( if different E-Mail: C u S t 0%t r 5 y s z c c,v✓L from the Owner luted above) State or County License: (b G L7 it value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUi PLEMEN IAL CONS i KUC.iION LIEN LAW INFOKMA i ION: DESIGNS 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: I certify that no work or installation has commenced prior to the issuance of a permit. st-Ducie Coun makes no representation that is grarrtin a permit will auti,orize the permit holder to build the subject s#ructure which is in con ict with any applicable Home Owners As�Doation rules,bylaws or and covenants that may restrict or prohibit such structure.Please consult with 11011T 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 exemptfrom undergoing a full concurrenry 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 twke 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 recWding your Notice of Commencement. Signature of Owner essee/Contractor as Agent for owner Signature of Contractor/License Holder STATE OF FLORIDAr STATE OF FLORIDA i COUNTY OF ,a. ,G U e l e- COUNTY OF- >7z- z CSG/". The Forgoing instrunlimt was acknowledged before me The forgoing instrument was acknowledged before me this V1 day of IVQ i ?r1 4,anJ 20 lbv this, day of N�CL�i � ,]o /y by �Urbs �tqfnmor)S LiZTI S St nilrMon 5. (Name of person acknowledging} (Name of person acknowledging) (Signature of NotaryPubblit-State of Fl a) (Signature of Notary Public-Stat of Flori Personally Known_✓ OR Produced Identification Personally Known OR Produced Identification Type of Identifica/t'ionn+Produced / _ Type of identificatti�onyProduced Commission No-6 a 0: '7 i! CHR1Sr1N�9 {?I L (� i^ � �7.�r � lmis5i0n No- 7 � �C�"1 t�l'�s:�� •.= t>�i6 mycommempit mom --..._ ------ — � owwa n,.auk�ate• - � -- ►Nt'�►ANssrorr#co .._ Revised 07/15i2014 * } OMM S" Avm+,war REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW i REVIEW REVIEW REVIEW DATE ' COMPLETE INITIALS