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HomeMy WebLinkAboutBuilding Permit Application 1 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J ? i Date: 4.5% Permit Number: /1( -10- V� V `) 4 F L a R e Q F11. . Building Permit Application 4,,R . • P Planning and Development Services. • pe 0� Building and Code Regulation Division 414i�9 ?v18, 2300 Virginia Avenue,Fort Pierce FL 34982 G'%�eAa IN Phone: (772)462-1553 Fax: (772)462-1578 . Commercial Residential C°ti 02e. • • PERMIT APPLICATION FOR: n.e_aii Com( •. PR®P®SED. INTPR®VEMENT L®CATI®N°:,., ;: . �. , . .r.. 4,.. .,y..... .., • , e;...., h Address: - . h/ A/ i/ Lv e71.Lef 1 Legal Description: _ • Property Tax ID#: /q 30 - qv/ - 00D z -Cod - K Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: • Right Side: Left Side: DETAILED DESCRIPTI® . W®RK,.:: m 1 ,� �%✓S // 5171.9 it • /94776/ 1)(fcaIL,.0%,c-r/ CONSTRUCTION HPORMATIONg ,,n, Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors —Electric _Plumbing _Sprinklers —Generator —Roof Pitch Total Sq. Ft of Construction: ' Sq. Ft. of First Floor: . Cost of Construction:$ ata C7 0 , c p . Utilities: _Sewer. _Septic Building Height: ®WN ER/LE-�SSE° . CONTRACTOR �� ° . Name m i h.-- &,4 e_A) Name: to& / -7-A o-Jryz4c rc/ Address: ya-(Id P# 4n1 /34.vd. Company: / c,,,,194-4,1) /r K. ..�1 City: rI Aa-ft ccs State:tZ- Address: e/?y- _s G`G 4 /L al.., • Zip Code: _.'.IT 9G/' Fax: City: PSL State:'Kt- Phone No. 7 72 675--5--- 5/ f'/( Zip Code: "3 zi l C/ Fax: E-Mail: Phone No 7 ?..2. , 34/1^//20. l.e/ Fill in fee simple Title Holder on next page(if different E-Mail S®67/t /r r .-3 `' A/,c ej from the Owner listed above) • State or County License I/ l 3 0 0 23 0 C If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUOMNI ENTAL OONSTRU071I© LIENIM INFdliMATIO(W . ;k; :, lYb 4 4x n w- . 7 = 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 commencing4work or recording your Notice of Commencement. xi.'ci,_- 7---------2/"------- Signature of Owner/LesseefColitractor as Agent for Owner Sigr ure of Contractor/License"Halder G`_, v- r STATE OF FLORIDA , OF FLORIDA COUNTY OF • L'lE le, COUNTY OF 1 LLJ CI�` The f rgoing instru ent was acknowledge$before me The forgoing instru ent was acknowledge before me this day of 1r1 t ,20 I A by this day of rI I , 20 tO by — II .a . _ lA PP 6 1 ‘11) RD li ', Th--Tr\in IIWP%(?)td (Name of person acknowledging) (Name of person acknowledging) C. _____ KS. ' 0 QC_-)\ 0 - i-::_-______ , 1 (L.._ it.t , Li-c9N9------"I • (Signature of� o�NCPu lic-State of Florida ) (Signature of Notary ublic-State of Florida) Personally Known OR Produced Identification N Personally Known OR Produced Identification Type of Identi ja-t ion Type of Identjion Produced Produced r t_, D J -' ��,�g0.Y',!L';c KAREN S. NIELSEN --- - - --- --- ���� �a (Seal) ,""° KAR ai) NIELSEN Commission No. '°� ,Aiu \ Commi ;i'fF 115637 Commission No. .� . `. MyCommission Expires E _�' �' .1.,,„,,o-til, P = - Commission # FF 115637 �: :,,,,,�; June 1 2, 201 8 N f ;4, My Commission Expires -'"%;,-,;,`:^ ::t June 12, 2016 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI. 1'�...'. '.- i'=` `" A- MV COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED 'iev. 7/2014