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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(� /� Date: Permit Number: / 1 v - /& C0LiINJT APRT®?O1B F L O R 1 D A Building Permit Applicatiikgo Planning and Development Services LusaCounw ept , Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 J ' Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ,, PERMIT APPLICATION FOR: -PROPOSED DEPROVEMERT L®CATI®No, .° . . a,.,,,,,,, ®.,;fib Address: 6.. ---0,:)__ ped 0 w10.1- p aY l< viol k N.T-• ft, F+ .p i t rGe Ft_ ,1,1-1,75--1 Legal Description: (11 i F&f Ru u 4 ,)- ,S r°r✓ Al - U n 1t II w a Z -IA r7, k,v&1 • IVB►nl pre wi 0,; co vi C�-e' e- pa at Property Tax ID#: 1301 r (015". ' C 135^' D c , 0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: © = D&SCRI'PTION' WORK? '4°° " , ,, '1 °: A/c Ch Aii9 td- )-_s`_ A/ g 14,14 7,6— Kw , Nem pre. hi & 4 Loy, cre±e p a A C®NSTRUCTI® IiNFORMATI®Na .. - ;,� . . ,i4 1 Additional work to be performed under this permit-check all that apply: V 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:$ ',V �0 • Utiliiiies: Sewer _Septic Building Height: 0 'NER/LESSEEo- . ; . ", .,,, :„CONTRACTOR° , $ :; . Name .CS L (nWegtwiJJitS 126--,pe±1 1---1-C._1---1-C._ Name: K'4 IV YLI I 'stun Address:/`06 ( .S SC. I on-t r-P-p Ril Company: CIT1 GbU li f Apt ,lht; City: cliA iLYt State: F-1._ Address: ,..4--)-4-0 N. . L8 v ay C Zip Code: 3 10 9 if Fax: City: t9 S ., f�. State: L Phone No. Ti )- 36 I 3)--)-7 Zip Code: ? 8-4 Fax: E-Mail: Phone No /7"-- 5)-t —a7 0 3 . Fill in fee simple Title Holder on next page(if different E-Mail Gi 11 and &()Li/me4c- 41114) _Ca hi from the Owner listed above) State or County License CAC. (S'f 7 73 5- If If value of construction is 2500 or more,a RECORDED Notice of Commencement is required: OWLimENT'Aii-txoriSTRUCTION LIEN ° 1�INFORMATI�ON° s �,° _ .3,...,:i., 9.. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: r _ 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 rec. o ed and posted on the jobsite before the first i ection. If you intend to obtain financing, consult with - .er or an attorney before commencing w)- or recording your Notice of Commenceme t. --">< 44t4i Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF • (-AA-CA''2— COUNTY OF -SA-- -Cmc k'e., The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this /0 day of kfri I< , 20 (Ss by this 10 day of k, 1 , 20 ( c by (Name of person cknowl gin ) (Name of person`�cknowledgrrl'g) 1 °ICI' \C/filNoj gnatur- o Notary Public-State ihf Florida) ` gnature of Notary Public ate of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced t=L11� :. Produced FL— I D .� ,CrR 'Lays LA ;; HNJ Identification,: —.4s1"�• L:5�; hN�A INGRAM � 1j a,�.o Itbfary,��h i� State of F �` """""�� Seal}-.State of Floridz - Commission No. 1='x "= + M c,Sealj lorida Commission NO. f3 a`paY�u,��,, 's + ° Y { /'pines DGi 2D16 iflotar; s pec 20.201a ;;,, �� oc �2,°��c s�rry Comm.E:cpire FOF F4oe�.. Comrnisshon x, _• �' s ;r FF 1"r7249 `F`177249 ��, el'.11 •gam niC, 0(1 �""nun• 6ondad ___. n F�',Rno,•n-t: o�a n sd threugl h!ational Notary Aasn.ii v— . - ry dsan,p� ;f off: -_. . ,% , '.: REVIEWS FRONT '"" 0NIING-- -"SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER —' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ley. 7/2014 I