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HomeMy WebLinkAboutBuilding Permit Application_i i All APPLICABLE INFO MUST BE COIVfi-LcTED FOR APPLICATION TO BE ACCEPTEL Date: 1 �-' 15. "�'o Permit Number: �© 2: Q J r5'To LCICc'flCR RECEIVED h DEC 1 �:1010 Building Permit Application PermittIP9 Department Planning and Development Services S uCie counh, Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: 1 72.4v .S t V14e l C 2 Property Tax ID #: ;2 -�3 o - L422—© Q 16 • nM - g Lot No. Site Plan Name: Project Name: D(AA t/15• (DdA" New Electrical Meter Second Electrical Meter Block No. Additional wor to be performed under this permit- check all that apply: _Me anical _ Gas Tank _ Gas Piping Shutters Windows/Doors _ Pond Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: 2. 04 Sq. Ft. of First Floor: Cost of Construction. $ 0 d m Utilities: —Sewer _Septic Building Height: x.�WNERLESSEEt���5�T4yy�- /;.CONTR ;wiTizn'+y e{Jt°Se�C:� Av$'id.'x5,a k ?rt'�.19*.k t`..,xi/Y+n, .f... T«`/ ."w.'m.tw'�u..�'�.-.r�J� h.�=z;43rl:'A �.aE''is.p- Name ��� {,J�r`.w..��S Name: 34 it0 00t`1� Address: Z Co i<k-Svsi\- Company: C J Address: Lm e SGI/ d o City: tom 8'elv�e- State: Zip Code: 3 !(rt''If Fax: City: G- State: Phone No.72 Z Zip Code: 3V ax: E-Mail: Ste �b •cam Phone No E-Mail Fill in fee simple Title Holder on next ge ( if different from the Owner listed above) State or ounty License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. �y xx4P 5. �: .8�+k,,=r�'3g' } A .f, ti" qt` 's `c`' " e �P(?LEMENTAL CUNSTRtJ TION, LI"EN LAIN INS®RMATIO�N �'�+•ri9 )^ 4'4t g�'' u`y �3+i".3aFd,e �r�rvac h ��3 � ER V t `xi�r �� DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: e"RN—ot Applicable Name: • okn 54-r Name: _ Address: (40 Address: City: &/--f- Re-rcL State: City: State: _ Zip: 7 Z Phone 75Z 37 5Y6 Zip: Phone: FEE SIMPLE TITLE HOLDER: . ' -oot Applicable BONDING COMPANY: ,- VI"ot 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 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 paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attornev before commencing work or recordinpvour Notice of Commencement. t1g_nat#of Owner/ Lessee/Contractor as Agent for Owner natur f Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA / COUNTY OF le.IF_ COUNTY OF �_ Lvn /[ Swor 'to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of ✓ ✓ Physical Presence or Online Notarization Ph sical Presence or Online Notarization this � day of lee 2020 by this day of �pP0, 2020 by .\ () 10IIV f-2—A()(EIr, .\ 0kin �O UEl S Name of person making statement. Name of person making statement. / Personally Known OR Produced Identification ✓ / Personally Known OR Produced Identification r/ Type of Identificati Produced Type of Identificaty�aa— Produced !� E__a�_4 A SY. ryti'.ia (Signature of`Nttabti�5t (Signature o ,, Iq LSEN ��� Commission J�tiP"Y PV B ?a° :Sfate of Florida-Notar Public =• *= Commission # $ 7484 ::Ill, KAREN S. NIELSEN l ;`�;�=��`'d�'• �- Stata of Florida-Notar is CommissiorP46.::;':1 ((y1$�� Pj My Commission Expires June 12, 2023 r; :• ;;� �� , �rnrn�mrssron # GG 20748�1 I '.,; : t� . h1y Commission Expires -' N..y> REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Te—V.5/6/20