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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ts �Date: / Permit Number: - 0orC�n - e RFC�IV�D Building Permit Application RAY 0,0 20, 'Planning and DeveloprrientServices permlrtlpsr y o Building and Code Regulation Division Lupe fou„ty ent 2300 Virginia Avenue,Fort Pierce FL 34982 j Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential _ PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: -J b� �C)ber�S Q� Sod E, @,f C._ D_ ., 3 LI q 5 i Legal Description: Layevooc)d PbAv- - Un�� 02- GLS Property Tax ID#:` /I 3 P 1- (9 OZ' d 1 1 ' ��� —(o Lot No. (- Site Plan Name: V b Block No. IJP Project Name: y0 1$A, Setbacks Front Back: Right Side: Left Side: ,DETAILED .DESCRIPTION OF WORK: i f (Zerr•ov�. p 1e, roo'F 'Sy s'rrrY. o,►�cl i I)sem,I I G s P ha I f S)l i r�l e. .ro0 F S ys }0h'1 . CONSTRUCTION INFORMATION: Additional work to be performed under this permit—check all appy: 11HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors Electric Plumbing F]Sprinklers FIGenerator Roof S�12 Roof pitch ,Total Sq. Ft of Construction: 2 H 83 S .Ft.of First Floor: Cost of Construction:$ Utilities:�Sewer Septic Building Height: r� 'OWNER/LESSEE: ,CONTRACTOR. ” Name Aon VoIsO- Name: (zobert em, J r Address: —1 LA O(o 'zobex�5 26, Company: D11100 200E i 1N� City: P i erC F. State: �L Address: 1 c1S0 SE Grt„oe la►,cl A��e I Zip Code: 3 L-I°151 Fax: City: P,-r4 Si• Lucke State: FL_ Phone No. _718 — &19-6010 Zip Code: 59C,15Z- Fax: E-Mail: Phone No. --7-7Z - -713- 72K0 Fill-in fee simple Title Holder on next page(if different E-Mail: D i I Ior,PoaF�rc,l 1 L o��10°I� •Cr)i� from the Owner listed above) State or County License: CCC, t33 I',W b If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONS��RUCTION LIEN LAW INFORMATtO,N �' � t a fi. 5 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 our Notice of Commencement. Sig ature of Owne essee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORID COUNTY OF _QAiyC.e.e_ COUNTY OF yUC.t.4__? , The forg ing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of �'YY��'�(�20 18 by this day of 2M 201 by Name of p rson making statement Name of prson making statement nown Personally Known OR Produced Identification Personally KOR Produced Identification Type of Identification Type of Identification Produced Produced (Sign (Signat SALLY MEISNER +" SALLY M Com State of Florida-Notary Commi EISNER �`�sYP, (f;State of Florida-Notary P& , � '_. ommis GG 1925 a GG 192 My Marchcommission 2022 fres �r My Commission Expiros ` +u"� ` March 06, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17