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HomeMy WebLinkAboutBuilding Permit Application i I Iii i ILL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: f -b Permit Number:I'.I oSIONI. Building_ Permit Application Planning and DevelopmentServices Building and Code Regulation Division I f 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1SS3 Fax:(772)462-1578 Commercial Residential Wmxxxxx I:IERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ° F?ROPOSED IMPROVEMENT LOCATION: Address: f U Co C° j Legal Description: i Property Tax ID#: ��S�U - SU - 12 '--17 U.!/U - ( Lot No, Site Plan Name: i.l i Block No. itProject Name: Setbacks Front Back Right Side: Left Side: i l DETAILED DESCRIPTION OF WORK: . Remove Usfing Pedestal Replace with new (--ONSTRUCTION INFORMATION: ` stiona wor to e e orme under this permit-c e a appy: ❑HwAC Gas Tank ❑Gas Piping _Shutters i�Windows/Doors El I ; Plumbing ❑Sprinklers El Generator ! Roof Roof pitch Electric © ` Total Sq.Ft of Construction: So.Ft.of First Floor: Cost of Construction:$ Utilities:0 Sewer 0S,eptic i'l l Building Height: OWN ER/LESSEE: CONTRACTOR: rJame C-5 IM c- l 4 a iget_rn Name:John R Law! Address:_ 124VIJ Company:Law's flectricaj.;Ser+rice Inc. City: �� i r h �.�c _ State: Address:5156 NW Primm,§t i Zip Code: Fax: City: Pt ST Lucie j j j,l State:FL Phone No. 1 - 7- .fo 3.� `� SS-C Zip Code: 34983 L•i Fax: E-Mail: Phone No.77237,943571 I Fill in fee simple Title Holder on next page(if different E-Mail:johnlaw5158@a0l_p9m from the miner listed above) State or County i,icense:l Zs432- If value of construction is$25Q0 or more,a RECORDED Notice of Commencement is required..j 6'd -99zK99-699 1 LV9£8L9ZLLMV1 d90:90 96 90 9a_� I � i �'1 I • { A� .�4 ,lY-=L! til' �`Vi1Y•.A�V. - DES�IG]NERJENGINEER: Not Applicable MORTGAGE COMPANY: • Not Applicable Marne: Name- !; Address: Address: I ' Gly: State- my. i Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING.GOMIPANY: Not Applicable Narne:, Name: ! JJ Address: Addre= I I!i CK)r City: I Zip: Phone: Zip: I Phone:' 1 certify that no work or instalMon has oontmenced pdorto the issuance of a permit I StLudeCourrty makes no representationthatisgrantiagaAermitwill authodze6thean �Itholder to build the subjectstruoture which is in contfict with any applicable Home Owners Association rulm bylam or and aouectaMs Drat may restrict or prohibitsuch structure.Please consultvi th your Home OwnersAssodation and review yourdeedfor apy restrictions vcEmcl't may apply. In consideration of the granting of this requested permit,i do hereby agree that will,in#1 respects,perform thework i in accordance wfth the approved pians,the Florida Building Codes and St.Lucie County Amendments• The following building pew applicatiom are a mptfrom undergoing a full concur .en y;revieur.room adcWor* accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another noidential use WARNING TO OWNER:Your failure to Record a Radice of Commencement rri I'l result in your paying ttdrice for improvements to your properly.A Notice of Commencement must be recorded and posted cin the jobsite before the first inspection.if you intend to obtain financing,consult with lender!or�an attorney before commen " work or record' our Notice of ComrnencemeaL I:a ,signature Owner}Lessee/Agent Signature of Qo ctjorlluerise Holder ,'j STATE OF FLOR A LC STATE OF lL O t COUNTY Of . te COUfflirof U r I�I:I 'The ftgoing instrument was acknowledged before.me The forgoing instcumentwasIacknowdedgedbefore we this day of . Zr 13y this qday,of i� .20 J-�c v (Name—of persort acknowledging l {dame r'son ad66,Ailedging j I,1 na A�a akro li4— & ! W1 of Notary Public-S Florida} nature of Notary{Public-State of Florida} Personally Known, OR Producer!identification Persmally ICriown i.+ OR Produced Identification Type of identification Produced Type of Identxfc6don;I odttced Corrtmission Commission IV0. � (Seal) •rt Revised4 EXPtREs/0.pn721,2CD MACh ,.~ M�itg4tOR REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATioN SEA I GROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE I ! INITIALS Z•d -8926-699-699 I L1;,8E9L9ZLLMV 1 d98:90 96 90 9aj