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HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED - Date \ \ . \\`A Permit Number: \c\01 0 TAS , REcE •i---,7! • ,,,, ,,, , „1/4, COLIINilir Y. - E L o R. 1 a F. -- .,__ J JAN 2 5 2019 jj Building Permit Appli ation Planning and Development Services Permitting Department Building and Code Regulation Division St. Lucie County, FL 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:.(772)462-1553 Fax: (772)462-1578 Commercial Residential • _ l PERMIT APPLICATION FOR: c\.\ ��..k.A- r PROPOSED INPR®VEMENT LOCATI®Ng . :.; • ;_.'. ;, Address: /72c At/VI-141V � L R• / • &M6; FL. �% ff./e-- Legal Description: Property Tax iD#: V14a - q.0 5- d lay - 4CIO 'S Lot No. 11 Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: . m) DESCRIPTION jWWORK? "-• Q.e- /.., o Pk+Sj;` r/ 2DG7-02_, • , 'D (7,e( t;ecY-441 7154K_ ONST' CTION OR INFMA CTIONo. o Additional work to be performe• under this permit-check all that apply: _Mechanical —Gas Tank _Gas Piping _Shutters . _Windows/Doors Electric iK,Plumbing _Sprinklers Generator_ —Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ (0 i Utilities: _Sewer _Septic Building Height: OWNER/LE�SSEE4 �_ : C©'T IT OAR: Name ��I .`�QFAP A • :('LCA r Name. La/1W- i /Tr✓!ZL- Address:= .. 05- __'_134 i`i!..Nfi'u ,�• / Com,pariy,:' -:'.Kc,1,F1a ' Plui/�j QLA/(� City: / ie /_C �L State:FL Address: J2Z / Q,4vaU$Wevap ,&", 5,Yr Zip Code: 3"1942_ Fax: City .44Ti✓r..4 AtifeK State:/`(, Phone No. 77Z ` 233. 777i_ Zip Code:ti333/ a Fax: E-Mail:_R JP./�)('Ol,r33D flu:jt , C6- Phone No. 7.`y, 3aJ/:x.:31_CO Fill in fee simple Title Holder on next page(if different E-Mail d kto fC�a.GI,/P/i/1-,,ttj. , <oo-, from the Owner listed above) State or County License e-Fe_/j/27( / If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. PPLE €0146 '&1'614'AN I7140611MAT104 R ' j DESIGNER/ENGINEER: \J_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 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 toanother 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 your Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF COUNTY OF FLORIDAL&. c_t` 2 COUNTY OF STATE OF FLORIDA S4- L� The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this I la day of NI ,20 18 by this ((p day of Nov ht.",-- ,2018 by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known k OR Produced Identification Type of Identification Type of Identification Produced Produced• ca 7/4 -NE /1 i-- dih— vim— J? lJes _4 mi LE A.nUChAlt ;�,wR/•• MICHELLE A.KUCHAR (Signature of Notary Pu icYo` ':�f.F_Lo a_ -state of Florida (Signature of Notary Py t - c j9ngiic)-StateofFlorida uu <a Commission N GG 245232 ` �% a Commission N GG 245232 of °° My Co ires Oct 5,2019 •''?'OF °'• My Comm.�Fdcg mOct 5,019 Commission No. . '('9e�R�� Commission No. },t�$5i, ,,....Bonded through NotaryAssn. Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ley. 8/2/17