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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: l' 34 'Lc, Permit Number: I O a,s_5'l • RECEIVED • 2 81019(Ftn - Building Permit ApplicationlAN Planning and Development Services permitting Department Building and Code Regulation Division St. Lucie County 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial , Residential PERMIT TYPE: PROPOSED INPROVEMENT LOCATION: Address: /7 C2O&JAJ �� �'r�G'�/�-� /�L • .75/7'T Property Tax ID#: /5/1/ ' 70/ "- 4/7 I — /o® Lot No. Ai/4 Project Name: _ /� 74.717e. W/✓e:41.c1S / .1)GG✓S' DETAILED DESCRIPTION OF WORK: /-64461/€._ ex l r,v 5 "Jo St,D//79 ela® AAT 4vi. Sit /h� avec /l/ eocAr SID UV//f C f ) ) � CONSTRUCTION INFORMATION: Utilities: _Sewer _Septic Sq. Ft. of First Floo : Cost of Construction:$ Total Sq. Ft of Construction: FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code thatare in the floodplain: Nonresidential Farm Building: Temp. Bldg./Shed used exclusively for construction Mobile/Modular for temp.construction office: Bldg. involved in distrib. of electricity: Other Flood Zone: BFE` Floodway?Y/N If Y, No Rise Certificate with supporting data attached?Y/N All other applicable state and federal permits shall be.obtained prior to commencement of construction. OWNER/LESSEE: CONTRACTOR: Name A4/ell/o4 // Name: /etv _r4714/0.04cAddress: /8 y86 �/4- e.c arr) / RI. Company: //Ad- SA-444/e4 S Me . City: Torr- S Lu47 / State: .. Address: //©/ 4/e- /0/970r-ha Zip Code: 'V1 e 7 Fax: City: tjeinceil ga t 1 State: - Phone No. .Se,/- SS 3 - 90 Zip Code: 5Y/c7 Fax: E-Mail: 1/C/1P/4e/il a r'vd& e stt.Q-i/- e- ' Phone No '772- 2 63 39 Fill in fee simple Title Holder on next page(if different E-Mail &4//S,47r7A4a,4S' /11 . & 46,! •c`` from the Owner listed above) State or County License eg,r7 3 26o 5'/4' If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: i 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 represu sentation that is granting a permit will authorize the permit holder to build thesubject 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. I 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 s WNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvemen' to your property. A Notice of Commencement must be recorded and posted on the jobsite before ' e f. nspection. If yo 'ntend to obtain financing, consult�with lender or an attorney before comm i /r • ecordi our Notice of Commencement. , dothd:, ��;:�— / Si d'Own_ /Lesse= Co. /-4r4r5 Agent for Owner Signature .f Contractor/License Holder STATE OF FLORID // • STATE OF FLORIDA COUNTY OF fieMil COUNTY OF X5"7 oCG-.c--t,T-e- The fprr oing instnt was acknowledged before me The foru4g instrument was acknowledged before me this/5 day of L ,20/ by this /, ay of Caay ,20L by Affi P�!n,i bIV - 0 uk Aws Sc..mrrrori5 Name of person making statement. Name df person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identificatiorf Type of Identification Produced ro ced FL b L I /rC�ii� C��t` (Signature of Notary Public-State of Florida) (Signa e of Nota pe'• ' . 11 ' NAN E FAJANS Theresa Anne Fasano State of Florida' Commission No : rk _ eal) Commission No. f=° i NAt�rymIsb1 t� p ¢s',, •-YPUBL CommisiMGIG237980 i 'sA:, 4STATE OF FLORIDA '�aF ;:241, ' My Comm.Expires Jul 18,2022 '�' o ;each 9irou�h National Nota Assn. E i 21 REVIEWS �$tb�VT � �a� SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.1/9/2019