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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN M rT BE COMPLETED rOR APPLICATION TO BE ACCEPTED -niDate: 0 l LRWEV Num r: 0 V 6upj!waad IA4uno�9i-nn'I '1S 3 2018 T, ty, Permitting 8102 19 DO Build pp kation Planning and Development Services GDAI]DI d Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:.(772)462-1553 Fax: (772)462-1578 Commerci I Residential �C/ PERMIT APPLICATION FOR: #�R13St} IIY �VE�GI\1 d' C�L � .szl Address: f9 S ! Inc Legal Description: Property Tax ID#: 1 n' �lJ I ' h�Y COO Y Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �V, ?WA� E �/:�Y/41 T/ c !Aib (941 1(,41L— ,/ AlS dPA6 I1AA.1J-D �7 �!t''"�'.� If : WF �`� zip r� -, TRV�T(4 �i 1,7I• MAT)ON''S� .vF $ �y P 'W. 3 a+ °" k ``h' Fa .Z'^`n Y? '.:: •c*.. :z; <+`'., ..+,+'z a,.al r1?..e ,�5�,' :.Ss 'e;.:.;..: iY,:4.^ s' &, .� .ler ' ". £.».. _ ... «a. e. .`�:.. Additional work to be performed under this permit-check all that appy: _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:$ �J © � , Utilities: —Sewer —Septic Building Height: ,.. 'Sc -.-nes '�°.,3 ,'.�,�._ .*t 's2.,.,, »r ,... ate. a" es" `w ''a_` W R L_E S m�24 b� a � �� GC TRAG'T"A' K a � ,_ ,�..n, rte;. ..a .-�'� , «'�.......'`��.' n": -a.�°a . Name •fes U �� Name: Addres G l ✓F Company: G•6'Cq 110 � 41 City: ®12T State: e- Add s �ri S®�: Zip Code: ILP4& Fax: City: - A- State: Phone No. 772, 'S/lf ���GrS� Zip Code: 3� (o� Fax: E-Mail: Phone No 77Z-'- 7ff, f Fill in fee simple Title Holder on next page(if different E-Mail C6��S Z), from the Owner listed above) State or County License ZV)03 21 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ,�� �` �'„;,>.' :s.:`A s_.y.>;s�—'c_9=�s.. ^�`'��' � -p"f`f�,..,•�� ,.�: : r-v.x.�'` �,�"�� � � -_ .°�.::??",�'.,'`._��,�� ���z..�'"?�,-'*� "�' � r ':� ;�':eF��`- ^: 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 is of a permit. St.Lucie County makes no representation that is granting a permit will authorize thepermit 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 in ction. If you intend to obtain financing, consult wi lender or an attorney before commencingw r recording ou tice of Commencement. Signaturener L ss tractor as Agent for Owner Signatu aCrarLi`ceAn6,HoIder STATE OF FLOR A STATE OFI f— COUNTY OF COUNTY OF The fp�gioing instr s acknowledggitbefore me The Jgrgoing instr ent was acknowledgep, efore me this 4fr-11 day of 20 liG by thit day of 20JZ by 6L :me ofrso knowledging) (Name of pers n ack owledging) Q JA (Signa ure of Notary P6lic-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification_ Personally Known OR Produced Identification Type of Identification Type of Identification Produced L. Produced ��1PpY P`I, \ EN S. KAREN S. NIELSEN �_° _State, NIELSEN Commission No. :o'°A "O:State o` $tom Notary Public Commission No. _• ° �` �Ipa Notary Public •"c Commi; i n GG 207484 COm�' ° ;Notary 207484 Nly C:�r. mission Expires °;;;°: Icy C°r:mission Expires June 12 nm REVIEWS F ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.