HomeMy WebLinkAboutBuilding Permit Application All APPLIC'A'BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: y Z' _ Permit Number: V To c) �
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RECEIVED
Building Permit Applicatio
Planning and Development Services APR 12 2018
Building and Code Regulation Division 15T• Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATI
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Address: 70 I-afLM Uvsye P5� fL 3 Y z
Legal Description:
Property Tax ID#: �j�� `� L,� �' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
405A LIQ
gi
CONSTRUCTION INFORMATION
Additional work to be performed un er this per -cckc a that appy:
—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: $ / !() Utilities: Sewer Septic Building Height:
Name nv&,fN R Me4oL Name: SEElLt6
Address: 124in 1_' -fok 0J,- Company: YLG dNx� I
City: �Sl State: tai- Address: SE el s ✓Q.
Zip Code: J Fax: City: State_
Phone No. -1�2• x.40'a• 161 Zip Code: Fax:
E-Mail: Phone No 77z L
Fill in fee simple Title Holder on next page ( if different E-Mail t/ /I S 4'/ �� NP
from the Owner listed above) State or County License CF( 3 2-
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If value of construction is 2500 or more,a RECORDED 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 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
commencing work or recordin your Notice of Commencement.
Signatu of Owner/Lessee/Cont6'ctor as Agent for Owner Signature of Contractor/Licens H der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C COUNTY OF
The fo oing inst ment yeas acknowledge before me The for oing ijnstru nt was acknowledged before me
this day of 20 by this day of 204 by
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(Name of person acknowledging) (Name of person acknowledgingA A Kko C 11 �' ' t L
)
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification�� Personally Known OR Produced Identification
Type of Identific Type of Identific
Produced L L Produced VT
F �o AREN NIE EN
°":a T63
fission No. L ss
Commission No. �a �F4SeaIjCAREN S. NIEnay C 1 37
' Commission FF "SSro� Expir� une12 es
My Commission E 201
" June 12, 201
REVIEWS FRONT UNTINU __1 E.M.-OR VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.