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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: S-1 -/ 9 gem Permit Number: • 6uillaing rermlt FtpplrfcatIvn Planning and Development Se; vices Building and Code Regulation Division, 2300 Virginia Avenue, Fort pierce FL 3452 Phone: (772) 402-1553 Fax: f772) 4662-1578 Commercial_ Residential c rcrtivii, xrru(,a I IDN f-CiK: To Select from dropbox, click arrow at the end of fine rnvr-%J.,)cU 1lv1l`Kt1VtMEN I LOCAI ION: Address: Legal Description,: Property Tax iD#:3�a`%©�"ODa (-�f%'� Lot No. Site Pian Name: Project Name: Block No. Setbacks Front Back: Right Side: Left Side: UE I AILED DESCRIP I ION OF WORK: 4e-� xo v o�-cka V /4 hxa-1 i�/ CONSTRUCTION INFORMATION: a worK to e rmed un3ef H`JAC Gas Tank Electric U Plumbing Totai Sq. Ft of Construction: Cost of Construction: $ _ "13 7 - cneCK a Piping Sprinklers apply: Shutters LJGene rato r Sq. Ft. of FirstFloor: _ Utilities: []Sewer[]Septic OWNER/LESS EE: ----- Name--3141,- L%ylar�e�y Address: 3.Z.2 5 .Sra�l o>< nn.,v�t 04 . City: P,3 2 t $t if tic i e State: T --L Zip Code: 3 4 R 5�- Fax: Phone No.- 77a e7q -i.4 7S - E -Mail: RII in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Windows/Doors Roof Roof pitch Building Height Name:_ CUifTIS Yr, tvoAc,r7S - Company: CU.5TGnt r 5'US e",k" lA,C;- Address: l lY15 Z E �l l d— G W r',,e iZ Q City: 21 St. ti .State: Zip Code: Z+? 5-1 - Fax: '77,2- Phone No. 72 a. E -Mail: C Li S -t S; cc, f� State or County License: C tf value of construction is $2500 or more, a RfCORM Notice of Commencement is required. SUPPLEMENIALC:UNSIRUC IfON LIEN LAW - INFORMAIION. ! SEfi TURTLE DESIGNER/ENGINEER: _ Not Applicable Name: 1MORTGAGE COMPANY: REVIEW I Not Applicable Address: ! Name: City: Address: State: Zip: Phone: City: State: i Zip: -Phone: FEE SIMPLE TiTLE HOLDER:_ Not Applicable ! BONDING COMPANY: Name; _Not Applicable Address: Name: City: Address: Zip: Phone: City: Zip= Phone: 1 certify that no .,ork or installation 'as commenced prior to the issuance of a permit_ St_ Lucie County makes no representation that is granting z permit Will authorize the permit holder to build the subject structure v:hich is in conflict with any applicable Home Owners Association rules, bylatiws or and covenants that may restrict or prohibit sucii structure- Please consult :firth your Home Oi,vers 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, perorrn the work in accordance vAth the approved pians, the Florida Building Codes and St_ Lude County Amendments. The folimting building permit applications are exemptfrom undergoing a full concurrency review: room additions, accessory structures, siifrimming pools, fences, :��aJs, signs, screen rooms and accesseR, uses to another noir-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 reco7-ddi your Notice of Commencement, Signature of ow; er/Lessee/Contractor as Agent for O;vner j Sig -nature of Contrac or /cense Holder S STATE OF FLORIDA J STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrumer•.t :vas acknowledged before rn i The forgoing instrument was acknov;ledged before n, this / day Of _& y 20G % hi. 1 this 1 day of �j�¢ y ,� r I by , 1 ;Name or person acicncr,ledging j (Name of person aclmoeOedging ) (Signature of Notary Public- Stag of F`c Personally Known OR Produced Identification Type of Identification Produced Commission No- I1-7 s.' YP CHRISTINE BEl (Signature of Notary Public -State of =!rric Personally Known OR Produced identification Type of Identification Produced Lit,mission No_YruoU Ct'Ri�: c _ ** MYCOMMISSION9 G052546 ��" EXPiRES:A/Pr22021 "v_ - �Ol T 60 2a.•fCm 71w &x' ^i tZa.z' ry 5erv��s �t1� pl(,� __�R ... r : BEH Re-vised 0;,1 --'V2014 �t RR,'IEkAJS I FRONT ZONING COUNTER I REVIEW DATE COMPLE T E INITIALS SUPERVISOR PLANS VEGETATION ! SEfi TURTLE iv1.aNGR01`E REVIEW i REVIEW � REVIEW REVIEIb' i KEVIEV6' 05MG