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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 121-1' I h. Permit Number: SCANNED :,�.. B St Lueie Muntp RECEIVED.' '. Building Permit Applicatio Planning and Development Services -JAN 2 3.201$ Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 ST, Lucie County, Permitting Phone: (772) 462-1553 Fax: (772) 462-1578 COI'nmerCial Residontial PERMIT APPLICATION FOR: To Select from drop box, click.arrow at the end of Line (PROPOSED IMPROVEMENT Address: Us U . Legal Description: EW 115�Q rvr�� • .! ni4 u (�i1(I& 01A Property Tax ID #: 3L{ 24 -1 q 2- bl yol - bop-Z Lot. No. 3 C) Site Plan Name: ' Block No. Project Name: 1"►r1r1A_r1\J©AnL-Lt: sul .QM Tn�5 0A al, 40 A Setbacks 'Front Back: Right Sider Left Side:' DETAILED DESCRIPTION F WORK y ., .�, _ ; �� at �=S�n` SSY1s�-a�.Uo-++ram ' , - • •5� CONSTRUCTION INFORMATIO;IV , % F y Additional work tore nertormed under. tis permit:- check all that apply, 11HVAC Gas Tank Gas Piping Shutters ❑ Windows/Doors _ .Electric 0 Plumbing Sprinklers :Generator':.. EIRoof 'Roof pitch. Total Sq. Ft.of Construction: S Ft. of First Floor: Cost of Construction: $ 1-1� �� • �� Utilities:Sewer E]Septic Building Height: OWNER/LESSEE, rTU COIVTRACTOR Name Wi llcnm" FOrryfS r -:Name Address:_2N5q:0o Egc te`s lk) nb - 9ll Company: zndaipy City: DAA:S{. UX.iQ State:A Address: `�3� Zip Code: 3LIglE L2- . Fax:- Cityt: of I A n State: -Phone No: -I12- $7-1-<?I.-g-,`4 Zip'Code: 324'19 Fax: E-Mail: lai'I- otYPS�Cr /+�� �E,,y�-I oolZ• Coly� Phone No. . 'y)-7- 9 30 E-Mail: j orimf �S r� 0,,X, VaDW JW tnw1 Fill in feesimple:Title Holder on next page.( if different from the Owner listed :above) State.oAounty License: CQ CS-7OCR(.2 .. If value of construction is $2500 or more; a RECORDED Notice of. Commencement is required. ------------ ' <. x. ,..t. `3` .: ', �• .: :me, � -f .' - F'"...; wi x. DESIGNER/ENGINEER. _ Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Name: Address: City: Zip: Phone:. Not Applicable State: BONDING COMPANY: Not Applicable Name: Address: City: 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 voJr Notice of Commencement. l( Signature of Owner/ as Agent for OwneC I Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF St Lucie, COUNTY OF — Sm O✓a,nctG The forgoing instrument was acknowledged before me this day of ,Tay, y&121 -, 20 I8 by Name of person making statement Personally Known OR Produced Identification Type of Identification Produced_-,>✓i✓,e+- Lice-nstQ_ The forgoing instrument was acknowledged before me this 15 day of Z 201& by LviS � �a✓5'pBin Name of person making statement Personally Known OR Produced Identification Type of Identification Produced-p,. Z v2y L ire-» 5L' (Signature of Notary Public- ature o o ry Public -State IRYOf%BE LKYS3ERf COMMISSION # Commission ltb BELKYSSERRANO . ( 5o ission No. I EjOMMISSION#GG161 , A F EXPIRES: z, Bonded Tbru Notary Public ' ers opa Novemb! '• 9,pdF , Bonded Thru Notary Pub& REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 oy.