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HomeMy WebLinkAboutBuilding Permit Application j All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A CEPTED Date:�- ��, -Z.� L� P rmit Number: � 0 - - Building Permi Application Planning and Development Services Building and Code Regulation Division t 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: XlC CupNt'PQ p PROPOSEDINPRWMENTLCATION ,Xput, I All ' ' Address: o i Legal Description: 1 Property Tax ID#:33 -5(3) - C3 t7-w), C© -- Lot No. SL2_ Site Plan Name: F.O Block No. 3 Project Name: Setbacks Front Back: Right Side: Left Side: M1Xt DETAIIf D FDESCRI�P 14N OF WQRK,r r ,.# _ , Ur off , #. , .=-WE -TO r . ,'D" A^h CONSTRUCTIONII�FORMATIQN z�ra$aa �5 �: Additional work to be performed under this permit-cneCK all that a p y: E Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors _Electric _Plumbing _Sprinklers Generator _Roof f Total Sq. Ft of Construction: -2224 Sq. Ft.ofirst Floor: i Cost of Construction:$ �� Utilities: _Se er _Septic Building Height: Y f 01NNER/LESSEE s p .t dw CONT CTOR xt .. { x x c w . �. I Namel&zt-l-,l-x� X56 ! cemCi= -4ot7 Name: e Address: Sgot7 C4L�,.�[�r ub l_�'� Compan ; �r � City: �� State:�'L Address 71 Mu Zip Code: c?34a9V==, Fax:' - City: - State:11. Phone No. Zip Code: Fax: E-Mail: Phone o(n-,,d go 1 - 3L-1 LV-5 Fill in fee simple Title Holder on next page(if different E-Mail U1. from the Owner listed above) dPrn State or County License: 'I !¢�2 } r If value of construction is 2500 or more,a RECORDED Notice of Commence l ent is required. 4 t .. � �� 3 a ' ''� -.,. � t �� .. r. ., 1 r a r _. - ' `� .. x _ .. � '. t t ...,. ..- .� ... 4 .. .. �t'� 1.' 4 � - , I i f• i 4 DESIGNER/ENGINEER: Not Applicable MORTG GE 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: s Zip: Phone: Zip: Phone: fi OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtai a permit to do the work and installation as indicated. s I certify that no work or installation has commenced prior to the issuance of permit. St.Lucie County makes no representation that is granting a permit will author ze thepermit holder to build the subject structure ? which is in conflict with any applicable Home Owners Association rules,bylawor and covenants that may restrict or prohibit such o- structure.Please consult with your Home Owners Association and review you-deed for any restrictionswhich may apply. I 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. Luce County Amendments. The following building permit applications are exempt from undergoing a fulloncurrency review:room additions, i accessory structures,swimming pools,fences,walls,signs,screen rooms and ccessory uses to another non-residential use. WARNING TO OWNER:Your failure to Record a Notice of Commen ement 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. f E Signature Owner/Agent/Lessee Signature f Co or/License Holder t STATE OF FLORIDA STATE O FLORIDA COUNTY OF COUNTY OF �Gk. LAAa e- The for' ing instrurDent was acknowledged before me The forgot g instruAnent was acknowledged before me i th49 ay of 20 'by thig _ ay of 20 'by ra.; (Name of peN on cknowledging) (Name of person ackn wle ging) F (Signature of Notary Public-State of Florida) (SignaturE of Notary Public-State of Florida) f Personally Known ,,gip face anti kation Personally Known ,,dlp uce en i tca ion a Pu''., DEBORAH RUSSEtC— Identification DEBORAH RUSSELL i Type of Identirication. r d B,'. Type of Pr ,; ? o ary u ? : . c otary Public tate o on a °•" ° C m+$sian # FF 179630 °�" Co n# FF 179630 Commission NO. :"� "o;� mea/) Commissi n No. ="^" "o; . i OFFS My Comm.Expires Nov 30,2016 -1 4- My Co m. pares Nov 30,2018 I 111,1 01, s f i € REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE s COMPLETED iRev.772n-4- 4 C .. � -) .. ., -�. f , .. � N � a