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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ! �031L - V'Ycx SCANNE® � �� BY � 'Aiding Permit Application FEB,1i tote Planning and Development Services permitting Department Building and Code Regulation Division St. Lucie County 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: 8Li/ D� n'S i� �z'-3Y`2S .�ssd Legal Description: 5 l 5 c. N-P rp J -f C . A i u e- i> tb C-r?a ev pfrR< mac. ? S ems' e� Property Tax ID #: -� © 2- ' S c) I `l g / - Oo ti Lot No. Z 9 5 Site Plan Name: Block No. Project Name: l��P[rfrc �X �S r-i.�rC- lci-/t 7G Setbacks Front Al1A Back: Right Side: Left Side: 4✓ DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: 5ona workto e e orme under this permit -check a apply: HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors 11 Electric O Plumbing F]Sprinklers _ Generator Roof Roof pitch Total Sq. Ft of Construction: 'I () S Ft. of First Floor: Cost of Construction: $ 307 C-0 Utilities:ll Sewer F� Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name /hl f r' / f 1 4'. `.�PF /I 2 Name: S l-lagtc-AA-e A U. k lu. 14 . iZErrrrre. )AX Address: /r-D Company: R tG/4rk-� D iALJ 0--A-A-Y City: S"A�� �� S ipaIA.Iy State: DiJ ,3, Address: 0- 10 .v a r1 si.­12E:-5's /Ok P Z- Zip Code: 0`l`l11161Fax: City: S 6--1 State: F �- Phone No. <5`i �l2- --cl gSJ Zip Code: 3 l S-7 Fax: 3 5r'i E-Mail: Phone No. 2 - 33 `t- Y'7 7 Y Fill in fee simple Title Holder on next page ( if different E-Mail: & h' )`'l cl Pi (5 I? A o L, • "rm from the Owner listed above) State or County License: CAC, 5-7Z-C-, S 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: _ N plicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phon�. FEE SIMPLE TITLEHOLDER: _ o Applicable BONDING COMPANY: of Applicable Name: Name: Address: Address: City: City: Zip: Phonee 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 vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF SLI COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of 120 by Name of person'making stateffient Name of person making stateibent Personally Known OR Produced Identification Personally Known OR Produced Identification Ty f Identification Type of Identification Pr du d Produced 4(" 01", 0'. . %-L Ng 111 !gnat re of Notary Public_ Stallof Florida ) *E ig ature of ta NoryPubli State of Florida ) Commission No. , (5� ''t�:$d:. - o mission No. ussy 6�elo euageN g6noigl (kso f „ r, ,ION leuolleN g6nojgl papuo9 �•o;',do� ,, WLLL JJ P, uolsslwwoo '03 :L L ad uolsslwwoo ¢a ,�, SLOE 000 saildr] AW REVIEWS FRONT V ODU aVJ n. 0 � OI I Q I • o?�� P NS lNtl VEGET � ? I V N l �i ILE and AUdy,,. p o COUNTER , MM �,RR l �,. IEW REVIEW REVIEWv R V DATE RECEIVED DATE COMPLETED tev. 8/2/17