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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED- Date: 5—i(e -d,6a Permit Number: L OF 1271011— -- _ - Building Permit Application Pldnning and De L-160 dent Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phi ne: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: 4 qt-,s.-i��t y ...sHY`..�.:.:« cr-_.c :' �r• 3'.c�-` ",,..'t*c:,.rl,2,r ��' ya FT�; v'x'' ..;'!ots'x'^a�" s '�-�'4�.'i 'R�� PRQP©sPUEi�I�EttATIC?RRk .er< 'YID , nn .._,"ar+..w,..*ro ..�5..-ry •t ,4W+,& / C�'"`.-.&- .:::#a. .ni-�"3 5r(a Address: �} ��� ;�Jlrirl C� e tl ce 3�c 3_( Legal Descri tion: � d �� �� 8. T VCt v(- U11 (4 (y 1811 L Property Tax ID#: L` � (pUtp;' —W® 7 Lot No. Site Plan Name: Block No. Project Name: - Setbacks Front Back: Right Side: Left Side: ` l,-�.,'v- il � " -2v`'H'S•r, 131` FtD:DECiIRt� � R -, ,� C e-W ' TC�NSTRI�CTlR /! 1 t r-._ t'xt,"y' a EeP s. Y•u'i v k' Y3- FT tis-` .cam„ r�.S` '+ •s:,.. ,...x.'�'{Y✓��`t��a,.Y.-.int'.';'iF•^�C' ^1•..w.*vc..:fePb as.snue ? 3 st RUN n-.-_; � �ts,4.� ,£� �ivu AdomonalworKICIDeperTormed un er t is permit—check all that at app y: —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:$ Jb , �j0,0 Utilities: Sewer Septic Building Height: I — — x' IN,.,.f,eic t ., • i .�... ` a' '. r' u.,yA^ '— i'^-,n-ra- r"-a, s°cuvv F 53 '. ,'"-t �-." sh ,e-a'i= r'�t: t : Name -2.C?, Name: Dam m C_!! =�R71 �I ISA,VK5 Ad dress: 't✓ Company: Pcez! , 1' ; City: , Address: - Zip Code: 3q95 1 Fax: City: tierce State:�� Phone No. '737 2(a7— q �� Zip Code: 3CL5 Fax: E-Mail: . Phone No Fill in fee simple Title Holder on next page (if different E-Mail f QZl e' a _(C _ Gtr C from the Owner listed above) State or County License CGG 133 Ly®I If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. kcRf-r 5 1s• 5 3 '".�n..'1-. r 4r' ''s RIMIN W� o Ms h-r• �,s 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 1 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:robrh 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. 3 ' Si h re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before,me The forgoing instrument was acknowledged before me this NU day of o.,._ 20� by this Ilo day of 20f3 by (Name person acknowledging) (Name of person acknowledging) i re of Notary Public-State Florida) (Sign ure of Notary Public ate of Florida) \ Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced .+� � Commission No. n (-seal) Commission No. Sea , Par LASHAHNA INGRAM Pav ria"" LASHAHNA INGRAM Notary Public-State Oi Florida °=°a `� Notary Public-State of Florida • Joy Comm.ExTes uee 2u,a,io (j * wiy i,c am. >.Fire,Dec 20,2,118K REVIEWS FROiN'% NING_MlS.�JPE�­VI SOR PLANS VEGETATCbN «<� SEA TURTLE' T' rIVIiANGROVE COU{VTERREVIEW'n` REVIEW'ssn=�` REVIEW REVIEW==- R�EVIWVU" '.''�-t L 'REVIEGV� DATE RECEIVED DATE COMPLETED ev. 4