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HomeMy WebLinkAboutBuilding permit application All APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1 ' �`� I Permit Number: O ^ O I RECEIVED �� = JAN- 1 7 7017 Building Permit Application pERMlrriING Planning and Development Services St. Lucie County, FL Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 / Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: �..,;. ,zer', ''� PR G P d SEO IN!?RO�/EMEN ` LOCATI+Ol � A k � , ,41�' < m+. ,.,...,tw. ,"sI Address: -ba 9 - S p 42 ct'i 1 l C 0®-�u r~ll Legal Description: Property Tax ID#: �J� � ©( �� ��©� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: f i�" " €- + �,i� ,a t� t{tit DEAILED}DERlPTlONO #W = RKfa , �� €#_ � �, �� � �y � � „ w�h x, �?".��.?��' 1N1 wf°: ,. F ,! _ '� <�.,sR xa, y-h �`6av...6Fi, �a" j,4. - .x .< ".k<�'<u.-, c-)C—(" I eL)?e te-hP S1 i e , Ti t�—n K. k l °d- G r o7 e rs i h: 7 Glc d" 2'► h��Y-c�a' c. ; iA, .� <3w% °": �u {�I'i s ray ,h �, °.,_ �i { ':..r^ j,r a:'� e^ai`."�'§ I� -�"z �xu .ay' ­44 ws �c,^t 9 alp r (f; 4wt T '���a '#�_ �` ,•fir. COSTRUCTI �� N INFORMAT'ON � . Ili�nq;,a ..�t�timr ;� .;� ,� is Additional work to be pertormed under this permit-check all that apply: _Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: 'c7 Z Sq. Ft. of First Floor: Cost of Construction:$ j a`,o Utilities: —Sewer _Septic Building Height: aP.. y f ."a f. OWN a'-."' .I .0 .t aS; s :dz sM It a<.� ER/LESS^ E^ � F� <, CONTRATQR. ��� ; � � � ° sae <�e.�, sim t^ .;4'?a�h?ta ,t ,. m iY".. 4 ?°� ��iB k�' .sWhlY'_ ll ,�-,.,, :a� a ,t, iry;+�'�""° e2-'�_.:� A fit... e1s. a-=. . Name (�..n w,f+: Name: f)o��c�l ZA 4D' ld I- ?i eV1a del Address: 37R.� �a,�vc8 � I,� �. C;C Company:rdLL-A►z��,,{-v e,� �i S � e .., City: �oy�'c ,, f,;uc.� State:i�L Address: �.ba Zip Code: Fax: City:�c,-�'C �uC o State:P:fL%, Phone No. -352-q " j Zip C Fax: E-Mail: Phone No 2-7 Z, - 3 -4 -- 7 ref 7 Fill in fee simple Title Holder,on next page( if different E-Mail from the Owner listed above) State or County License ;-,�q-6 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. E. �U�a I c� ' �NTP,►�1:CC}IUS�'� lI�CT�C�?�I�L� I�, >U1lx I `C�3.��1�/fP}���T"��y�. � "�; �. � ��` �� �>���� , 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 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 co,ncurrency 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 commencing work or recording our Notice of Commencement. , .ram Signature of Owner Le ee/Contractor as Agent for Owner Signature of Contra r%License Holder STATE OF FLORIDA STATE OF FLORID COUNTY OF A.U1C',I�_ COUNTY OF Weir, The for oing instr ment was acknowledged before me The forgoing instrument was acknowledge before me this-U day of 200_ by this—11 day of 20-LV by u0 (Name of person acknowledging) (Name of person acknowledging.44 ) �rAAe — (Signature of Notary Public-State of Florida) (Signature of Notary-Public-State of Florida ) Personally Known OR Produced Identification I/ Personally Known OR Produced Identification Type of Identifi tion Type of Identification Produced LIU iduced _ KAREN S. NIELSEN ission# FF 115637 a, ,n, KAREN S. NIELSE14 Commission No. . ( I�'' C mission No. µ . (�®al�nission# FF 1 156 7 r arr y 0mmission Expire �; O'FF`° June 12, 2018 .,6,�fef`c`�: My Commission Expires �������•� .,,,,,,;���` June 12, 2018 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEPV REVIEW REVIEW REVIEW REVIEW DATE RECEIVED d DATE COMPLETED ev.