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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE OMPLETED FOR APPLICATION TO BE ACC ED Date: Permit Number: �.� �� CaL o . W. Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential - PERMITAPPLICATION FOR: PR®POSED 1NPR©VEMENT L®CATION1 Address:20 8/-V/ .��NSE-iJ -_-A C;4iPX 7 Legal Description: l' ecz-/ %Ai L1/F'-ffj_E_S .T S'f ri 0 sEc• i Property Tax ID#::A��/ 'c� 01 00 8?J --0 00 -0 Lot No. /V Site Plan Name: 6�YfL E S X- LAND Block No. Project Name: Setbacks Front ill f1 Back: Right Side: Left,Side: DE AILED DESGR° P 10N OF W �.RK; ra,Gmya FRK:sfiiNg LL 3/� �B EL, IT ,9A0�JQr I/WbE @, 01 tGSJ rA/ IJ -y GIAL VAI-tIm /V{U-- tA 1 Acor,'IV5. CO�NSTR U CTIO I'NIFO R+MATI O'N iWiTional work to be per orme un er t is permit-c ec a tat apply: _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:$ 8' - Utilities: _Sewer _Septic Building Height: OWNS % SSE• CONTRAC 0'R Nam r Name: A d d r e a, Company: v; ! .V aty. "� : .!_ r., State 9 RI{ f f7•: j Yid j 1 =� Address: �� �X ..�7)-�? ✓y�'yr" r., � Zip C ;y �prn' Fa ,. NOS. City: l`�nh� 75itk7 ��.testate: Phone No.'' Zip Code: .33, 345?_ Fax:7�ol�a3 D4,q - E-Mail: i+ A Phone No "77�A-ate/37P-7 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 61 MA SUPPLE ENTAL 1! NSTRUCTI�®N LIEN LAW INF®'R,11/IATI®N. DESIGNER/ENGINEER: _ Not Applicable MORTGAG COMPANY: _Not Applicable Name: `7/A Name: /V/-A Address: Address:' City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable Name:�A,LC F6RCh�L l�,_ Name: / �f Address: 9t9R i_ E` l-62- Z-fW-) Address: City:c_kA/,r,_'/1L BX-Ar-A, "L City: Zip:34L9S";1' Phone: 77 b 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 1-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 inspection. If you intend to obtain financing, consult with lender or an attorney before comme ng work or recording our Notice of Commencement. 'a, L,//, V/ 7Ag� Sign ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder.(/ STATE OF FLORIDA j STATE OF FLORIDA rr ` COUNTY OF Sf- L�JN,( -e. COUNTY OF )CI,( 'e The forgoing instry.nent was acknowledged before me The forgoing instrurnent was acknowledged before me this 0&( day of F QQL� f S 20J_a by this�day of Ee b COaLq, 20 //-1 by 0,01'r(0,_ �_(Son exur-e- k &-6-KhkDO(I (Name of person acknowledging) (Nam of person acknowledging) 0 q'i GL- Ctd_a,_ /lam (Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida) Personally Known -----OR Produced Identification Personally Known I--- OR Produced Identification Type of Identification Type of Identification Produced Produced CARLA'NELSON ��y Commissi , , �,L NotaryPuDllc-State(8d:��Ida Commission No. ; b.'s CARLA +: . a Notary Public-State of Florida = Commission#FF 965535 Commission N FF 965535 .�r fd Comm.Ex ires Feb 28 2020 ' REVIEWS FRONT ZONING my tiumm.cKpires re SUPERVISOR PLANS VEG VE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED �. DATE COMPLETED ev.