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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1 a:1 N.S1 1-1 1 Permit Number: 03 Building Permit Application 0 7 OR 9 lu 13 Planning and Development Services DEC 15 2011 Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resid lal••••••. X ......••. PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line D CAL I PROPOSED IMPROVEMENT LOCATION: Address: 1 ZS3 l"ETTLE2, '64N D �: NSe-ry ,F-i . 3 L1912 Legal Description: NI?T rL` /1-x. ACan.,Da �sS�c�nn►oN - Sec`Tfow I( M1�1r [cel_ 1293 4'v4 Vro - VZA aA s t4A<F- W Co mma-N W-ewi arA--s Property Tax ID #: 14-D'Z- 5© ( - I H 80 -o 00 — (= Lot No. Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: Block No. �ECbn1S'tNc.°T-rt�'�XLSTty� .S-Mt^,A dkk^A-r l., CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all n apply: 0HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors Electric F-1 Plumbing Sprinklers []Generator g Roof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ IDIOM S Ft. of First Floor: _ Utilities Sewer ElSeptic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: 5e-z>tt 6zAV-YLA a5 K,I Address: IA3 P % Va Company: or �!&eLkCk0__C14,, /AA-21nZ City: iN.ieN &AC4 State: Address: L572--5' S Zip Code: 9 512 Fax: City: PS State: %. Phone No. -3`t9 ���. ��-Z2��i— Zip Code: 3LR_'5�2 Fax: E-Mail: Phone No. -7 '1~ 3 . -- 7pg Fill in fee sim le Title Holder on next page ( if different E-Mail: C' L t CB from the Owner listed above) State or County License: If value of construction is $2500 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: 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 ' to d o obtain financing, consult with lender or an attorrr before commencine work or record lice of Commencement. !/ /C tract as Agent for Owner Signature =FLORI Signature o se Holder STATE OA STATE OF FLORIDA COUNTY OF 5 1, 0C oz COUNTY OF 3 -)r.. "t'-\ e The for oing instru ent was acknowledged before me The for oing instru en was acknowledged before me � this �� day of e C 20%1 by this day of C 20n_ by �65-% Sz4-V-fg+A-Ski C6}� 'Saq-�CgAS,kI 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 Identificatiorl Produced �' L L- Produced >✓ L (Signature of Notary Publi tate of Florida ignature of Notary P lic- G�v�n Commission No. � 6�1 AOPRN#GGQ V0 0 SS10 �16.2eTMm�e Ila.502.3 10N#GG02 1e� ommission No. S:D 16,12070 ,v+n E,NotaN� and mb ••�Pq"e MY Del", �nJ ad a; Z° REVIEWS .-°, T FRONT of ,,p•� G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTEe REVIEW REVIEW REVIEV# REVIEW REVIEW REVIEW DATE RECEIVED I DATE COMPLETED II.16 l8 tev. 8/2/17