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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: '"T• ,7s-• 17 Permit Number: s- RECEIVED ' Building Permit Application APR 2 5 2017 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 � i PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED I�MPR�UEMENT'L�CATI®N: Address: 1 1 - ' Le al Description: ;_ vWr vi i rnn 9 b C L IA�ba k QR IAAqe. P Property Tax ID#: �2 3-6 D-402 / W6 / — 0 Q0 /S Lot No. Site Plan Name: /� Block No. ; Project Name: I/L /�'�ql�ayl Setbacks Front Back: Right Side: Left Side: I D�EI�AIL�E® DE�SCf�?IPTI®N U`F U170'Rl1C: - (�_-rvv o v& 4 r�ss� (f'lac e Ft l( d ev pac t Fay- 30--7 u 50-7 q Y11.5 �,(-l-lr� J 3 I�z�lG Z�S'�ti �Fo of�'Ssr %�1�I•��� �Al .75.F �b L'�irct !�'l�t�l �u,tlre r CONSl"R+IJCTI®N 1N,F®RMA►TI©N: Additional wor to e e orme under t —checkispermit a apply: 11HVAC Ei Gas Tank ❑Gas Piping Shutters ❑Windows/Doors ' I Electric ❑_Plumbing — Sprinklers Generator Roof Total Sq. Ft of Construction: �V 0 S I Ft. f First Floor: Cost of Construction:$ 3 5c Utilities: _Sewer _Septic Building Height: ' I OWNER/LESS=E: - C®NTRACT©R: Name er Name: �n�l Iy�l(15 i Address:.: 1: d0� Gff� rt Company: C G� [9Z tc �Pi� .City: T i State: Address: 33( svyt U/QC' 7�' r,n Zip Code: ccFaz:" City: FT �L�e/Y•L p State: Phone No. -- 7 7J:0+�S3� 7 Zip Code: 3 y9 q3— Fax: y e40 7 E-Mail: / e S66 It,/'IC'/A' Phone No. 2 4 / �'3 7� Fill in fee simple Title Holder on next page(if different E-Mail: 1 i from the Owner listed above) State or County License: C eC If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. . I I I SUPPLEIUI'EN1' C®.NSTR,U 1®N LIErN 1 �UU INF�ORI\/IAT!®N;. 181 _. . 4—M' DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable Name: '%hoo S �(fl h Y4G Name: Address: lv0 S PGr/ t pw York- A ve- Address: City: Dt� Gg'VWQ State: City: State: Zip: 32-7_zO Phone: 396 7.79 9V y Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: 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 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. s _Signature of Ow er/Less �e� Signature of Contractor/License Holder STATE OF FLORIDA Y, STATE OF FLORIDA COUNTY OF S 4-Lin.0 L-e— COUNTY OF S�-• LUCA e The fo^r��,oing instrument wal_acknowledged before me The forgoing instrument was acknowledged before me this day of �fL,(`U1X_ 20 aby thisc9s day of A00 20,L�7 by (Name of p on acknowI d 'ng) (Name of person acknowledging) (Sig ture of kopdry Public-State of Florida) (Signature of ota�ry Public-State of Florida) Personally Known OR Produc d Identification_�� Personally Known OR Produced Identification Type of Identification Produced i-� a of Identification Produced I(IMBEBLV R.JAILLcn � l q1 Commission No. �ii 9 E'�S a °� glary Public,State of Flori C mission No. i $ CommisSlofe Jury 8GG 52 20 "x� YN 0 DRAWDY VIV comm.e)# °': •• MY COMMISSION X FF198 •.d EXPIRES Febmwy 1t 2019 Revised 07/15/2014 ao7 '"415t Nomry�rvin.aoir. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE (� INITIALS