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HomeMy WebLinkAboutBuilding Permit 'i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number. Building Permit Application MAY 19 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 PERMIT APPLICATION FOR: PROPOS Address: S ©KJ V C7 Legal Description: Property Tax ID#: ! — U� — V y 63 — V V C)W�it Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Ba Right Side: Left Side: DETA m LED ESCRIPTIO OF WORK: , C o C, c� r�c, it onal wor to e per orme . under this permit—check all that 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: $ �' Utilities: _Sewer _Septic Building Height: OWNE; Name 0 JJ Name: Address: 0 V J12=KVE Company: F n , City: State:L Address: t 9' Grr Zip Code: Fax. City: ��1 State: Phone No. `7 �� , �rS Zip Code: 2. L _ Fax: r E-Mail: —I Phone No AAl� Fill in fee simple Title Holder on next page ( if different E-Mail 5 w A from the Owner listed above) State or County License CicFt' rn 1'1 &I If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Adak 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 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. r Signature of Owner/Less Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA ' '`" STATE OF FLORI l COUNTY OF t=I COUNTY OF The for oing instrument was acknowledged befor rite The f r oing instrument was acknowledged bef Ls,*#,V this day of 2021 by Xil- 'n this;day of 20�7b g - `�o a a mm z m�m � ��c (Name of person acknowledging (Name of person acknowledging) Z 9 � _V< • v �N ( gnature of tbry Public-State of Florida) (Signature of ary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identificat n Type of I n tion II i Produced V ^� Produced Commission No. (Seal) Commission o. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. SINOTICE OF COMMEN04MENT • TO BE COMPLETED WHEN CONSTRUCTION VALUE EXCEEDS$2,500.00 OR WHEN HEATING OR AIR CONDITIONING REPAIR OR REPLACEMENT EXCEEDS$7,500.00 PERMIT#: TAX FOLIO #: State of clorida,County of Indian River,the undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with chapter 713,Florida statutes,the following information is provided in this notice of Commencement. 1. LW L DESCRIPTION OF PROPERTY (AND STREET ADDRESS IF AVAILABLE)' 2. GENERALD S IP j ION OF PROV MENT-. 3. ❑OWNER INFORMAT ON or❑LESSEE.INFORMATION (If Lessee contracted for the improvement) a. Name: 6 ttI N-' l-:� t Address: 67� �S b. Interest in pro erty: k� c. Name and address of fee simple titleholder (if other than owner): 4. CONTRACTOR: p �� a. Name: l� Address: RA 07 b. Phone number: 0 j 5. SURETY COMPANY(IF Applicable, a copy of the payment bond is attached): a. Name &Address: b. Phone number: Bond amount: b. LENDER/MORTGAGE COMPANY: —� a. Name &Address:— b. Phone number: 7. PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE SERVED AS PROVIDED BY SECTION 713.13(1)(a 7., F ORIDA STATUTES: a. Name &Address: h --- -- b. Phone number: IV fax number: __- 8. IN ADDITION TO HIMSELF OR HERSELF, a. Owner designates of to receive a copy of the lienor's notice as provideV I se do 3.13(1)(b), Florida statues. b. Phone number: 4. EXPIRATION DATE OF NOTICE OF COMMENCEMENT: (THE EXPIRATION DATE IS ONE(1)YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED). WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,SECTION 713.13,FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF(SECTION 92.525,FLORIDA STATUTES SICIURE OF OWNER or LESSEE or R'S AUTHORIZED OFFICER/DIRECTOR/PARTNER/MANAGER SIGNATORY'S TITLE/OFFICE M THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS�1�L DAY OF ` r 201 BY: AS 11 — FOR NRME KNOWN — PERSON TYPE OF AUTHORITY NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED � ERSONALLY OR ❑PROOUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED r �. NOTARY SIGNATURE NOTARY PRINTED NAME NOTARY SEAL CAROL L.BUFFUM* * MY COMMISSION i FF 121976 JOSEPH E.SMITH,CLERK OF THE CIRCUIT COURT A EXPIRES:August 17,201, SAINT LUC1E COUNTY +rE����O� Sorded Ttn B%d*Notary Se youi FILE## 4310669 05y19/2017 02:52:08 PM OR BOOK 3998 PAGE 1567-1567 Doc Type'.NC RECORDING: $10.00 r