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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAIX 'PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Dat'i:®T LOICJ SCANNED Permit Number: BY Till LucieCounty P-ecEzvEo BMWBuilding Permit Application AUG 1 ®2017 Plan ing and Development Services pe ode Regulation Division 230 VirginiaCAvenue, Fort Pierce FL 34982 st!LU a coun�Yent Pho e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PER IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IIVI'PR`OViEMENT LOCATION ;. x Addrls: 13 11 iC In :Qel � AA a Legal escription: La+ 3b ',n WoLK 69, on Xy\c ac\yi ckiUar E:ANVg5 r r� I?a° Prop ty Tax ID #: ��4O)fz — cog ®39 6 - ®o0 ` 7 Lot No. _ Site P an Name: Block No. Proje't Name: Setb cks Front Back: Right Side:_ I� Left Side: CO ISTR.UCTION Addi,lonal work to je ner orme under this permit — c eca app y: L_ HVAC _I Gas Tank Gas Piping _ Shutters a Windows/Doors U Electric 0 Plumbing Sprinklers E Generator 1:1 Roof Roof pitch Total II q. Ft of Construction: © S . Ft. of First Floor: Cost f Construction: $ Utilities: Sewer Septic Building Height: OW ER%LESSEE t��=� � ��`��, s. :CO�NTRACTOR� � ��F E Nam Addr City: Zip C Phone Fill ifee E-M1�� fromhe 14il�CA Vmckylw 1 YJ Name: ©GJ���x Company: ss: it Ri cCIn � \i 2 � :� PIS?C( 'L State: VL ' de: Fax: No. 1112 2 C ^ 273 5 122 497 - Li35 Address: City: State: Zip Code: Fax: Phone No. E-Mail: il: i,19G IC]LtkkMaXgv1 -_!RMCA3,jC©m simple Title Holder on next page ( if different Owner listed above) State or County License: If val4p of construction is $2500 or more, a RECORDED Notice of Commencement is required. S=J PLEMENTAL'`CONSI'RU:CTI,ON LIEN LAW IN'FO.R'IVI'ATI0'N DESIGNER/ENGINEER: Na Ad City Zip:, _ Not Applicable e: sL��/%��� MORTGAGE COMPANY: Not Applicable Name: (�u��k�� LoaY,S i�G. ess: Address: ` Im5�y�©o&A` eR A,.wvij City: �@ Ces% State: I�r Zip: 40r22(o Phone: &OG - o, )- M44 State: Phone FEE Na Ad City Zip:I IMPLE TITLE HOLDER: V Not Applicable e: BONDING COMPANY: _Not Applicable Name: ess: Address: City: Phone: 1 Zip: Phone: OWI��R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certi that no work or installation has commenced prior to the issuance of a permit. St. Lu a County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which s in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such struct re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In con ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accc rdance 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, accesI ry 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 impr8ivements 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. IL Sign ure of Owner/ Lessee/Contractor as Agent for Owner ST E OF FLOR DA L—U �J <- COryINTY OF 4r 9''"," The rgoing instrulnept was acknowledged before me this o day of 201_g� by Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of , 20_ by Name of person making statement Name of person making statement Personally Known OR Produced Identification X. Personally Known OR Produced Identification Type of Identification Type of Identification Pri d ced Tx, Produced (Signature of Notary Public- Stat Florida ) Commission No. (Seal) ..�,,. (Signature of Notary Public- State of Florida ) Commission No. (Seal) ch ��m T RE"IEWS FRONT pkyl PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW 1J-im g\q REVIEW REVIEW REVIEW REVIEW DATE cSExmco REC .IVED Ao JZo c DATE CON jPLETED a X O1 T O Rev, 8�112/17 -4 Q G