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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RE EVED— Building Permit Applicatio SEP 0 6 2018 Planning and Development Services Building and Code Regulation Division ST. Lucie County, Pyr kkin� 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line fL/t/C PROPOSED IMPROVEMENT LOCATION: . Address: 6 i�©� a� /�! �ST!q s C��2f, /�®2%!�IAy1_1_L41I/tlieldD ll 1-564A0/ Legal Description: A1//4L0A10XI 7/�_:_,&k2. 0W ,t74k I LOQ' 7 Property Tax ID#: I D3-5_00-00/57-600/. Lot No.� Site Plan Name: Block No. Project Name: MXA(A,EL&&D aFMKI E Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF,WORK;' 11V- 17411— CLO A101 A tLIM11VOP1 F, & RWLW& IN-5/19E PR6101Z9?Y LIA16 Ar RW A.,QV SP'6-/eS'IPIz5 (SE SORV&Y) 14e1-0,P1AJ( S tX 6,47,=5 CONSTRUCTION INFORMATION: Additional work toe e orme under this permit-check a appy: HVAC Ei Gas Tank ❑Gas Piping O Shutters F]Windows/Doors 11 Electric 0 Plumbing Sprinklers Generator E]Roof Roof pitch Total Sq.Ft of Construction: S Ft.of First Floor: Cost of Construction:$ Utilities: _Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name M/a,4/24 of A4, ;4014Fk RAA/! Name: Al, OCT-1 Address: gy09'Qca4V r�s'r i,LS CT. _ Company: SCIS-7r I-EW15 CCAI:6i,LLG City: f T, i'Mec45 State:L-L. Address: 86 6oK 2-3q6 Zip Code: 3g'7'V9 Fax: City: ? Lim 8&419 State: /Ez Phone No. Zip Code: 33z/5re Fax:.!5;-61 33`03/L) E-Mail: Phone No. 5_61- 7757- 2240 Fill in fee simple Title Holder on next page(if different E-Mai1:SC'0 rrL&l50bNSr OLAe r1.6A1Q9MA ,cei'4 from the Owner listed above) State or County License: CCC JS-0 7� y If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LEEN 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: V Not Applicable BONDING COMPANY: V Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is leer by made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior 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 commencin work or recorclipaiLmir Notice of Commencement. c S natu Owner/Less 'ent for Owner Signature ofcontractor/ficenW Holder STATE OF FLORIDAt STATE OF FLORID��X COUNTY OF �J'lt�?ky1 2Rt��� COUNTY OF n—) The forgoing instr ent was acknowledge�before me The fo going instr ment w s acknowled efore me this day of LA S " z0 jL5 by thisay o I 2� by M 1 Name of pe n making statement Name of person making statement Personally Known x OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Idepttf_ic atio My YANIRAJ.PENA1 AM7 Produced Prod NOTARY PUBLIC STATE OF FLORIDA n (1 Expre FF124360 E 1Expires 5/19/2018 (Signature of Notary Public-State of Florida) (Si nature of Notary Public-State of Florida) 1rLg6Com ommission No. (Seal) COLENE K.ISRAEL Notary Public-State of Florida FF 943959 REV 111 °� ��'� FNbWm.E,p%UM,212)1UPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17