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HomeMy WebLinkAboutappALLAPPLICABLE -INFO MUSST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: %SCEMD Building Permit Appl-kation Planning and Development Services r �r ?iir'iP•� tv Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce Ft 34982 / Phone: (7721462-1553 fax: (772) 4621578 Commercial Residential V OERMT APPLICATION FOR: To Select from dropbox, click arrow at the end of line re -=APO©-' jam? 'w! x .._ d (, rs r u �(.N'�S *t gilt. .Y -x e ,.y t e• T�i1.-', -�` ,: Y r c f �7YIIYIrL�FY R,TLi{� T4�d wart - �' ..c.. ,.�.. ...:.•r. N .�• 5 �_t.t�. .. �.,.7. �'r�. '"t4 f < �-�'��. Td 37z. t� - Description: P-'\y •e ( pG ( �— U V') 1 1 9 Pa (4- C (-� ( K� q ( L 0 +-- (P Tax ID #: cJ� k� J � �i� - � O � - C�Cc) Plan Name: Name: Front Back: Right -Side: Left -Side: Lot No. '4' Block No. j �o S{a t k (t S1 sty Oe � lvGA -5v C;i%c jj IIHVAC L__J Gas Tank [Pas Piping 05huiters 1 Windows/Doors [:],Electric _Plumbing OSprinklers 1:1Generator TRoof Roof pitch tat Sq. Ft of Construction: J-OLt S . Ft. of First Floor: ist of Construction: $ id 4'30 0 ' Utilities: oSewer t =tSeptic Building Height: WIR ro M•fi..S;rvx -..fig, s ..J,.:.t FL....+a.. i..: k�£ ZN ..,r' ,.,., = >,..k_.e-�T..;+.1'.., ".«.,.:.,,,E Name V r1 C� q-- An n') a, -Name: ff r e Qi M pfIIj Address: iJ3 � `- 4-I-,rb - Te rr . City- 5- 41AO-+ State.. - Zip Code: '3, ylltQ Fax: _ Phone No.. 1-7'%0L �aD�, �� E-Mail: Company: Of, �AGe- 00-F1 11 Address. 1q/5 5�5W-R•_ MAi ib9l AW, City: '(by--i-.State:--:9— Zip Code: e3L r) K-Lq Fax: Phone No. % � d Fill in fee simple Title Holder on next page (if different from the Owner fted above E-Mail (� �7 E-` o S (✓ 12 `x Y1�1� C � ) State or County license: C CC / 3 �0 $1(451-1 If wake of SonstruWon is S250e or norm, a RECORDED Notice of Cofpm encement 6 required. -Not Applicable !. MORTGAG€ COMPANY: _ Not Applicable Name: f (Name: Address: City_ Zip:_ Address: State: city, State: Phone I Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: - - -- may: - Zip: Phone:. Zip: Pharke- 0VVNER/ CONTRACTOR AFFIDYIT: Application is hereby -made to obtain a permit to do the work and installation -as irid'rcated. 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 tar build the- subject structure which is in conflict with any applicable Home -Owners Association rules, bylaws or anG QQvenaRU that may restrictar prohibit such .structure. Please consult witfi your Home Owners Association and review your deed for any restrictions wfiicfi ritay apply. consideration o€the granting ofthisrequestedpermit, 4 do hereby agreethat i will, in all respects; perform thework accordance with the approved -plans, the Florida Building Codes and -St. Lude County Amendments. ie following building permit applications are exempt from undergoing a full concurrency review: room additions, cessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use rARNiNG TO OWNER: Your failure to record a Notice of Commencement may result in your paying twice for iprovements to your property. A Notice of Commencement must be recorded and posted on the jobsite More the first inspection. if you intend to obtain financing, consult with lender or an attorney before immencinis wnr% nr rernrdinis your Notice of Commencement_ Signature of Owner/ ee/Conti actor as Agent for owner Signature of Contra or/License Holder STATE OF FLORiDA<�,,J L G STATE OF FLORIDA (' / COUNTY OF / C� COUNTY OF C� tJ l The forgoing anst n�twaas acknowledged before me The forgoing instrument was acknowledgrlbefore me this 'J day of p. 201!5 by this by cJ e F��-�/ �%r�� S'��--� SFr l �mp�SbAJ Name of perion making statement Personally Known OR Produced Identification Name of p rson making statement Personally Known OP. Producedidentification Type of identification Type of identification Prockiced produced (Signature of Notary Public- StAte of Florida I (Signature of Notary Public -Stake of Florida ) Commission No. S PROULX Commisgon No. �`�,yP1 ONST NC PROULX CONSTANCE State of Florida-Notar Notary Public a:° o�c State of Florida -Notary Public _. •_ Commission # GG 258328 =• ° is omm ion Expires ,,�oF.� nm, ��, y ommis be ion xpires 6 REVIEWS OF ��°`� Z& mb r g PLANS V�GET CO W REVIEW REVIEW REVIEW REVIEW DATA RECEIVED DATE COMPLETED s/z/17