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HomeMy WebLinkAboutBushong.SLC.PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: _Z 2- 2- Permit Number: ��a Wcm O Building Permit Application Planning and Development Services 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: �I � 00f 4- Wilde h&U V r'' 1 P_ PROPOSED IMPROVEMENT LOCATION: -- Address: _5'd0Q �6_( 1 JGt-- C--t- Property Tax ID #: 3�-4 2_ 7©; _ E)t 9 Z - Doo - 4 Lot No. Site Plan Name: SEAaa- G(,,v rj Block No. Project Name: f DETAILED DESCRIPTION OF WORK: I Reply ,f e h - cue L)+ v l e-n, i pe t% r n cc, ,I, &:g _,0 e 5; r (mac e__ � E New Electrical Meter Second Electrical Meter I CONSTRUCTION INFORMATION: Additional work to be performed under this permit- check all that apply: Mechanical Electric _ Gas Tank Plumbing Total Sq. Ft of Construction: Cost of Construction: $ —7; jqq. oo _ Gas Piping _ Sprinklers _ Shutters Windows/Doors Pond _ Generator s Roof Pitch Sq. Ft. of First Floor: Utilities: — Sewer _ Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name � Name: Address: 0O 'QDD(l� ��GL. C+ Company-T k0e_eA It lywt bej, ;L-FC City: Porgy �j�-. j i� Stater Zip Code: 3qgS2- Fax: Phone No. 516- 514o 00-C, Address: City:,?&f State:*`"L- ZipCode:�Ct5 Fax: Phone No 77a'�-3 Z2 E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail M0_rtkg_6 i✓loof +�1�17)ism ber State or County License Cis is II{ �,q357 wuuce VI _ummencemem is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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: e 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 fail a to Record a Notice of Commencement may result in paying twice for improvemen to your pro rty. A Notice of Commencement must be recor d in the public records of St. d to obtain financing, consult Lucie Count nd posted the jobsite before the first ins4ofntrac with I nd r an at me efore commencingwork or recof ommencement. 4r/Lic Sign tune o Owner/ L see/Co tractor as Agent for Owner Signa e Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF Y. COUNTY OF S ► •• (..o C. 4 Sworn to (or affirmed) and subscribed before me of Physical Presence Swr n to (or affirmed) and subscribed before me of or Online Notarization this 2,& of �1�.�r��.�a 2021L by �/' Physical Presence or Online Notarization this 2.4 day of c ,%WCi 2gW- by iday -- _ lLc.�/ l ✓1 ' ice' y�,'�Ct' Name of person making statement. Name of person making statement. Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification Type of Identification Type of Identification Produced Produced 1Y"e WAYNE C PARKER (Signature(g Notary e Nof FI } tary , MITI, • State of Fionda (Signature Notary Publi t Iprrate o on a _•r Commission # HH 041279 Commission No. „ofn,: y Comm.(iJ04s Sep 10, 2024 erna; Is # HH 04t279 My Comm. Expires Sep 10, 2024 Commission No. REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS VEGETATION SEA TURTLE MANGROVE REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 516120