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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` I • '(11� Date: (i Permit Nu mc%.c.LvcD C/ 6- C/ i NOV 2, 0, 2018 Building Permit Application Planning and Development Services G ANNED Permitting Department Building and Code Regulation Division BY St. Lucie County, FL 2300 Virginia Avenue, Fort Pierce FL 34982 , Phone: (772) 462-1553 Fax: (772) 462-1578 t(I`O - Phod pa Residential PERMIT APPLICATION FOR: To Select from ropbox, click arrow at the end of line� PROPOSED IMPROVEMENT LOCATION: Iq p Address: �% /� .i � I O 2 Legal Description: Property Tax ID #: %l y " 00 l — QOt Site Plan Name:�}Ll��, G��S Project Name: W#10 AINA q Setbacks Front X Back: �C� Right Left Side: Lot No.J Block No. DETAILED DESCRIPTION OF WORK: H®vs r-v CoiVslI v room l �D ��ol I 4',� c/�/� �#X�/= CONSTRUCTION INFORMATION: Add itional work to jbe nej orme under this permit —check h a apply: �IHVAC l-1 Gas Tank ❑Gas Piping _Shutters Windows/Doors Electric ®Plumbing XiSprinklers Generator � Roof Roof pitch Total Sq. Ft of Construction: 7 S . Ft. of First Floor: Cost of Construction: Utilities: _ Sewer O Septic Building Height:` 9- r -,� I OWNERAESSEE: IV CONTRACTOR: Name ffilVl7?�l'�lf�1s.6 V/;' 114 Name: Address:_J��y Tl%, ��� /��� ��� %/ Company: G City: ,�%'I/n C/ �, Stater Address d I of city: - State: L-� Zip Code: lr1 Fax: Phone No. %/ �L%, 21?f% Zip Code: ��1'%�r Fax: Phone No. 1n%2 - ?41 '99/�� E E-Mail:IG-� E-Mail: `%jam A!20it 0 CQ Fill in fee simple Title Holder on next page ( if different from the Owner listed above) 1 State or County License: It value of construction is 52500 or more, a RECORDED Notice of Commencement is required. P -E SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION: DESIGNER/ENGINEER: Not Applicablel Name: G'� /alCi{ g MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: Stater WPu-hone City: State: Zip: •- Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: I Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is he4y made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior tolthe issuance of a permit. St. Lucie County makes no representation that is granting a which is in conflict with any applicable Home Owners Assoc structure. Please consult with your Home Owners Associatii In consideration of the granting of this requested permit, I ( in accordance with the approved plans, the Florida Building The following building permit applications are exempt from accessory structures, swimming pools, fences, walls, signs, WARNING TO OWNER: Your failure to Record a No, improvements to your property. A Notice of Comi before the first inspection. If you intend to obtain commencing work or recording your Notice of Co Af Owner/ Lessee/Contractor as Agent for STATE OF FLORIDA COUNTY OF The forgoing instrument w s acknowledged before this aTday of 26 1_1 by Name Of perso aking statement Personally Known OR Produced Id( Type of Identification Produced (Signature of Nbt�ry Public- State of Florida ) Commission No. (Seal) REVIEWS FRONT I ZONING COUNTER REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 rmit will authorize the permit holder to build the subject structure ion rules, bylaws or and covenants that may restrict or prohibit such and review your deed for any restrictions which may apply. hereby agree that I will, in all respects, perform the work )des and St. Lucie County Amendments. idergoing a full concurrency review: room additions, een rooms and accessory uses to another non-residential use e of Commencement may result in your paying twice for mcement must be recorded and posted on the jobsite nancing, consult with lender or an attorney before mencement. Contractor/License Holder C UTNTYOFE OF ORIDsA The forgoing instrument was acknowledged befc W this day of X1 U'1%• 20L& by Name of peison making statement " it Personally Known ✓ OR Produced Identific Type of Identification Produced (Signature of No&� Public- State of Florida ) Commission No. (Seal) SUPERVISOR REVIEW 1 I RE EW I VREVIEWON I S EV EWLE I MANGREVIEWVE