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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: °/ 1 ' °dcPermit Number: igtq- O , 4111111111111111h CQU N T'Y ~ ' E ii a. (R. (L •IY ." - . MINIIIIIMINIMINNIIIIIMMINIMP Building Permit Application aPR ?1010 Planning and Development Services Permitting department Building and Code Regulation Division St.Lucie county 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENTCLOCATION: Address: 5-- -I r7 ?, ►`,c.4"1"d OV ¶4) 11 tn.(' 314 6ra- Legal Description: (1414,h 'Q,-t ver" (3 f Vit1- 64) ' 4,0 �ok ‘2) IW, Lf1 Uukl'l VI- \55' %) k,oS),- 20 ,43 Property Tax ID#: 3 'J' �01 0 I,6 00 0 1 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: h* I bit t:i- LI latII) S ,14„\?tit (1,tl \ id CONSTRUCTION INFORMATION: Additional work to be erformed under this permit-check all apply: El HVAC Gas Tank nGas Piping Shutters ,E1Windows/Doors ElElectric 0 Plumbing ❑Sprinklers El Generator III Roof Roof pitch Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$ 22 5-6 Utilities: Sewer El Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name c."-(-''S- 11--) en 3 SLSCin Dei-)nen Name: I^ g 1 f�ti �3c."-(-''Address: 61 [es.- Padr 2 do p1&. Company: .1_t c 00- 5 , '_- 6,^tv- z S' c;s(i' City: 3Y A--R ii- - State: Fl Address: S Li-, .I‘( t`CLe✓ ,. Zip Code: 3q%`1.— Fax: City: 7.4- 5-1 k4 (64`.4' State:? I" Phone No. Zip Code: /. -{44-- Fax: E-Mail: Phone No. '4-S-9- SY4 l' ‘." Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: Cill,L (IC t 19-3 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. sty 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 recording your Notice of Commencement. Signature er Lessee/Contractor as Agent for Owner S ature of Contractor/License Holder STATE OF FLORIDA / STATE OF FLORIDA COUNTY OF �G'�'„ COUNTY OF S\.Lk)CI The for ing instrument w s acknowledged before me The forgoing instrument as acknowledged before me this day of /rr Y? 7 ,20 by this^ day of 411 l\ ,201P) by I. 44A iON1 ? ` V.7VilsSrGL)� Name of son making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification_ A Type of Identification Produced Lin...-&"...j Produced " c 1. ' 1 1 j 01) of r.1116.__ )--------I- atu-e of Notary Public-Sta of Florida) (Signature of Notary Public-State of Florida) G O[ e9.z, �o,,f y' David Singh Commission No. (Seal) Commission N V l3 T' NOTARY PUBLIC fi 7r =,,; STATE OF FLOR! f • �� �itlli Com n#GG06393 ``��FYPUe�' i ncununin IUGRAM �1 _ - . Expires 1/281[0' 1 A z�, `c'. Notary P iblic-State of Florid REVIEWS FRON : * , ,4©Ntr pcomrr.S.,U,RERMISORo 8 PLANS VEGETATION SEA TURTLE MANGROVE COUN Fia9")!j., EWcommssiiREVIEW7249 ,PLANS REVIEW REVIEW REVIEW _ DATE '' 07,E - Bonded d through Iyauuiiai Notary Aa . - RECEIVED --.L.,------,---.,• —7:--,:" DATE COMPLETED 1 Rev.8/2/17 1