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HomeMy WebLinkAboutUntitled All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED r Date: 5-- lJ -/7 Permit Number: ` _ -.03F7 gemiggami ' LN L Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: De,v0),,,_,..0)..) PROPOSED INPROVEMENT LO CATION MTle. 8/vifNse4 B e4et, SL . cl i7Address: im Legal Description: �e '/es yf/47? J C. (1060 -19g3) Property Tax ID#: 1/502 - 5-o1- 0,20V-000- 1 Lot No. /17 Site Plan Name: ./1/e#/e1 Block No. Project Name: . 18. Setbacks. Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK C(2m,9Je/-e o1.'717-0n ay;of 'i.e.*, Vo f of "03;4 A©me 041 eaeir CONSTRUCTION INFORMATION Additional work to be performed under this permit-check all that apply: Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors , _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: 6? / Sq. Ft. of First Floor: D 75 Cost of Construction:$ /y0o otUtilities: ewer _Septic Building Height: s7/421 OWNER/LESSEE CONTRACTOR:;' Name Reciter /// 1.1ve14)41 i I Lac . Name: ah i?3r7`'!� Address: 7,2/3 57.4 Avt: ✓Y Company: i� .1/n f 7_LA i oAc4.7L ) • :rt c. City: F rt ,[� e State Zig Address: (Id/ ✓1/�• .S�/^c4" ,�7 Zip Code: �D 3 4 I Fax: . City: j-e.ise4 f w OA State:/L Phone.No. ?2-7q3- //e37 Zip Code: 3Y15-7 Fax: 77)-2-3,2-219/ E-Mail: Phone No 772 --.2‘--.2‘,0 `3 7/3 Y / Fill in fee simple Title Holder on next page( if different E-Mail a G/am_sr, .7%inc a/2as. • cowl from the Owner listed above) State or County License CBC 1,257 98/ If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION. DESIGNER/E GINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: - Address: Address: -------- City: JCity: State:_ City: / State: Zip: Phone Zip: QPlione: FEE SIMPLE TITLE HOLDER: Not Ap i+cable- BONDING COMPANY: Not Applicable Name:_ \ Name: Address: `A dress: City:_, _ City: Zip: Phone: Zip: \\ Phone: OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to o e 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,sign's,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 r-cordingyour ► •tice of Commencement. // —..-1/'_' ..Zr -41111 .., Signatu''!o -Owner/Les ontractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA J. STATE OF FLORIDA , COUNTY OF T . � - COUNTY OF . b../t-C.4_12,_ The forgoing instrument was acknowledged before me The forping instrument was acknowledged before me this (Oday of /(/J'L- ,20 /c/by this ( day of ,20 4ri< by Id Aihr\ 6//1"Ce' (CYl'Al f0 aC__.- r (Name of person acknowledging) (Name o person cknowledging) VD W� (Signature of Nota Public-State of Florida) (Signature of Notary P blic-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification _ , �T„-� 6 Type of Identification ,�� h Produced TA-11)/--- y'' % Produced 7,'- .`ZJ r uni„F,ARIEGIVE�a --''� �1�Plhn GG p�2U 3 e '.. 11:,,_2^,- .1-7:2.1 .-:..\_, MY CO EAlSS1ON#CG 022073 Commission N� SCS ,c�anlssi°�(Sealy°L° t,<< Com ';;14:."3.4r., ,61.411' s'Ua�^mt r1s.�t4a1) y t Y a, g:Decent lartwn,ti 1 Ecrden TIAru I otaly P 1 , 1R lig r c)PInE publlcll;'' 1' ,: . ,S” REVIEWS C1-5 FRONT • ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED 2ev. 7/2014