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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f I Date: Permit Number: EC' d err�..�. ^-^. � 4 Building Permit Application pg Planning and Development Services JUN If 5 20417 Building and Code Regulation Division FERMITTENG 2300 Virginia Avenue, Fort Pierce FL 34982 St. Luce Coi.gty, F1 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential oat t t[C n►t PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I PROPOSED IMPROVEMENT LOCATION: Address: 17 `1 S- STD A/Y l.3ro,b K Pt. 5 Legal Description: Property Tax ID #: ­0 07.5_�- 00 c) _ I' Lot No. �1, LO Site Plan Name: Block No. Project Name: new l4ovnc -I,, 5fgll t do vt Setbacks Front Back: Right Side: Left Side: _ DETAILED DESCRIPTION OF WORK: 1n S}-�i� « r►�,w '� (9ti`I `Sac,ol�se� wtkhul -�ktt�r�c1 14awL a civic/ �dnVt-e C..t All Coi%CV eAr_/ 5tre(7s) aeJJ;'t"0v%S 4 51��r�4-�hc� �to be loen4nr"'ej b7 0+kees. CONSTRUCTION INFORMATION: Additional work to jebe orme under this permit— check a at apply: ©&VAC L__I Gas Tank ❑Gas Piping n Shutters a Windows/Doors YElectric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch Total Sq. Ft of Construction: l S Ft. of First Floor: Cost of Construction: $ t S-O a ° 0o MX I 00 Utilitiesll' ewer []Septic I►q1 i Building Height: OWNER/LESSEE: CONTRACTOR: Name per-5 ti t,vt Ymo i c / - 6411dih Uh �ne:We-K i th i4atrr1 rtg+A r` Address: 00 Ge h fond P- company:�arrtn�}���5 City: ft pl a rc e, State: Zip Code: 3 gc(4 �_ Fax: Phone No. yl9 6 gy l t lD Address: V 9 0 O Poo X F t e1 o1 Sr S C- City: PC4IM OC4)e Zip Code: _ xcf Ocl Fax: l21 Phone No. 3 1 1" 2 S e - 3 8 r6 Stater "T 7-i ? em's E-Mail:. Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail: W e •► J f,1% kt 1,06 1 b A o 1. C o m_ State or County License: ,?..}i. 101.5/P 3 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY•. _ Not Applicable Name: Address: City: State: Zip: Phone: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: ONot Applicable Name: BONDING COMPANY: _Not Applicable 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 your Notice of Commencement. Signature of Own Lessee/Contractor as Agent for Owner V, � -?4. __� s Signature of Conte6ctodricense Holder STATE OF FLORIDA STATE OF FLORIDA `� �� J COUNTY OF COUNTY OF The for oing instrument was acknowledged before me I The forgoing instrument was acknowledged before me this � day of 2017 by this day of 20 J� by � I ) rin 0 11 q-n r-ri ag'-6 Ll W 0 (Name of person acknowledging (Name of person (Signature of Notary Public- State of Florida) (Signature of fttary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced �1 . 1� i Type of Identification KAREN S. NIELSEN nR!n.95C@cw/�.Tabr.!CS..rsl.�+an,��ue°-.a:S.i^Esa4T+e.PVp�ni. •°" 2EN 9V'VELSEN Commission No. =_ - Commis(Seal') FF 115637 Commission No. �o I! ? M Commission Expires S= Commission # FF 115637 = `N Y P M m is 4; 4FF��`June 12, 2018 ; June 12, 2018 y — — Revised 07/1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER ;REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE y INITIALS