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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAL' APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED D 111 te: �T _GAN��ermit Number: 5q - St. Ludo Coun,N RECEIVED -- Building Permit Application SEP 0 5 2018 Pi nning and Development Services ST. Lucie County, PIrmitting B 1ding and Code Regulation Division -- 2 �00 Virginia Avenue, Fort Pierce FL 34982 / P�Ione: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential !/ 7MIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Ad ess:©D o l®,firy A�Yen! c> P ,� 2-t D/,,�Ge v�L. 3y9S/ LeglllI Description: Pro erty Tax ID #: 1 ? aLeno , n 1` 9 • Coe) - 0 Lot No. Site Plan Name: Block No. Protlect i Name: Se backs Front Back:. Right Side: I 0 . Left Side: I DELI AILED DESCRIPTION OF WORK: 1 //jQ -17a,V Na i CO INSTRUCTION INFORMATION: itiona workto e performed under this permit - check a apply: i� HVAC 11 Gas Tank ❑Gas Piping Shutters Q Windows/Doors _ RElectric 0 Plumbing Sprinklers E]Generator Roof �z 3 Roof pitch Tot I Sq. Ft of Constructjon: :s� �'v Ff S . Ft. of First Floor: Cos of Construction: Utilities Sewer Septic Building Height: O VNER/LESSEE: CONTRACTOR;, Na e A,& Owl Name: G(JR Ate..G✓% SSe- Ad ress: c OO& Compan � o/�s Ci�2 0�` -nle— I'.2� ��2ce State: �`� Cit Addr s: f.0, L x izlv5 6�7 C,a Am 1 /3�' e 7-z ZiplI I: Code: 3y9s / Fax: -�- Ci !%6' o•v / r' State: N. G Phone No. 77Z -'%8- y83G ip Code: o1 7 Fax: E- ail: P�'aQvi s �T4hoo . Co►A '77Z 76yG 99 3� -36 i- Ydty Ph/or I n fee simple Title Holder on next page (if different Fill E-u' Ga c%,vR ,AR a /s . froi'n the ------listed above) I'll Stunty icense: FL G/3GlZS �22 If v ue of construction is $2500 or more, a RECORDED Notice of Commencement is required. S I PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DI SIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable N Ac me: Name: Address: dress: Ci Zi y: State: Phone City: State: Zip: Phone: F1 E SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ^Not Applicable Name: Name: dress: A Address: Ci y: City: Phone: Zip: Phone: Zi OIA NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I ce tify that no work or installation has commenced prior to the issuance of a permit. St. L icie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure whi h is in conflict with any applicable Home Owners Association rules, bylaws or andcovenantsthat may restrict or prohibit such stru ture. Please consult wlth.your Home Owners Association and review your deed for any restrictions which may apply. In c nsideration of the granting of.this requested permit, I do hereby agree that I will, in all respects, perform the work in a 'cordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The ollowing building permit applications are exempt from undergoing a full concurrency review: room additions, acc sory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use W 'RNING 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 be-kre the first inspection. If you intend to obtain financing, consult with lender or an attorney before co mencinl= work or recording your Notice of Commencement. of Owner/ as Agent for Owner 1TE OF FLORIDA r UNTY OF . Iwo, I� _ 'Ing Instrurpent w rday of acknowledge efore me 20by Name of person making statement sonally Known OR Produced Identification e of Identification duced 1 —11-1 oI L I S-, nature of NotaryPublic- State of Florida ) mission No. EWS IFRONT COUNTER C MPLETED Rev. 8/2/17 KARE001)NIELSEN Tate of Florida -Notary Publ Commission # GG 207484 My Cornmission Exoires REVIEW I REVIEW 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 Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public- State of Florida ) Commission No. (Seal) R I PLANS REVIEW I VEGETATIEV EWON I SEATURTREV EWLE I MREVIERVIOIVE