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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.a: ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� (� Date: I I�I �� SCANNED Permit Number: 1y v 5 �� p ?Ct( St ILudP rm int, '' Building Permit Application C(� �%ns Planning and Development Services ©ne✓`� Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 / Phone: (772) 462-1553 Fax: (772) 462-1578 Comm' rcial Residential ✓ PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I Address: &6 60 Legal Description: S NO _ /T I 0 r r v c_ y r t I J vrF/ Property Tax ID #: /A?/0 3 — / 36 — c7a O 1 —=- 7 Lot No. Site Plan Name: Block No. Project Name: 144 Setbacks Front 2_5�_ Back: Z Ste_ Right Side: 145 Left Side: / o , ,V�/ DETAILED DESCRIP.TIOfV 'OFORK: arS„ ays_ _ .I.. .. x..t . c.'f'._L4�a"fir ✓..:?•si :.mti„ dfar,itvn r H .aci`� <f>el�uYs•0 .e..e: � ,1r..,K;R z. ,�Me^.r5..t.� !'' ..✓ . f• ri. ±�.< '?� Ga. £• �.etiSc�%-e• .E�i:�lrt. •�••p'•� Adclitional worK to (e�e orme under this permit- c ec a apply: CJHVAC LJ Gas Tank ❑Gas Piping Shutters a Windows/Doors _ ❑ Electric 11 Plumbing Sprinklers ,Generator Roof Roof pitch Total Sq. Ft of Construction: S . L. of First Floor: Cost of Construction: $ 2V, 000 Utilities: Lfsdwer []Septic Building Height: Name Address: 3-lo2- ,4t dw y .44 30 City: /a7L1,C' 11 State: r-z- • Zip Code: W Fax: Phone No. 216 2,(6 E_Mail / Si7�i4 c��J Fill in fee simple Title Holder on next page (if different from the Owner listed above) Name: e- Got,- -,74J I LOB' Company: L . roe-r Address: L 7os /9 1, - s4 /� A-- Z City: 1/eV_0 g-cz, � Stater Zip Code: `60 Fax: AJi Phone No. 9S-/) *V`/— &/zg— E-Mail: �!-,i3.3067 404_. C0 •mil State or County License: C'Cae, a,5S-A If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ENT, IN GINEER: Not Applicable Name: & 5 Address: city: State: IT_ zip: 96-? Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: S4wdr A Ctv,yAGC'/G IU% Address: City: Zip: Phone: MORTGAGE COMPANY: �� Not Applicable Name:_ Address: City: State: Zip: Phone: BONDING COMPANY: // Not Applicable Name:_ V4 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 Associations 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. Signatureoof Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF The for oing instr ment was acknowledged before me this day of 20 4 by -AbheK Name of person making statement Personally Known OR Produced Identification Type of Identification Produced Dn1'ae't (Signature of Notary Public-%tate of Florid Commission NoAdr 9 L971 SUNCXAUDEJUNBAM o Notary' Puft State of FM Commissio 0 GG 41551 REVIEWS COMPLET Rev. 8/2/17 Signature of ContraaA Holder STATE OF FLORICOUNTY OF4 ;0 12` The for oing instru en was acknowledged before me this day of r-e 20_a by Name of person aking statement Personally Known OR Produced Identification Type of Identification l f Notary Public- State of Florida ) `fi=F 1 G3 ?-3 No. LAU "LION * * MY COMMISSION # FF 176373 s t EXPIRES: February 7, 2019 COUNTER I REVIEW I S REVIEWOR I REVIEW I PLANSVREVIEWEGETATION I S REVIEWEA LE I MANGROVE