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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1-7- - 171 �)r,t--&vu7tv-) A10APPLICABLE INFO MUST BE COMPLIL-,.=J FOR APPLICATION TO BE ACCEPTED Date: \�S a, �� Permit Number: i i ----- - SCANNED ERECEIVEDSt BY Lucie County T 3 0 ZO1gBuilding Permit ApplicatioPlanning and Development Services COurtty, f��pffil5iing Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 4624553 Fax: (772) 462-1578 Commercial Residential PERMIT IAPPLICATION FOR: PRC�VE�M"E LO T)ON. Address: 76D 6a-DVC-,/LS /Z 0dD EZW_' Pl C%KC-rL Legal Description: Property Tax ID #: l 3 l 3 ` 31 - ©©O T - ©®U - 57 Lot No. Site Plan Name: 1-3 (1 C,H/9✓),,,/L/ Block No. Project Name: 7z u C t9 AM/U i Setbacks Front Nf ffi Back: N�Right Side: Left Side: ZN5 -riq 1.4-r< ©icv �� ���ti� - i3 K6CIL-1-6 211 T D sZ M7 An Adaitional work to be pe rmed under this permit -check all that apply: —Mechanical _ Gas Tank _ Gas Piping — Shutters _Windows/Doors Electric — Plumbing — Sprinklers ')t- Generator _ Roof Pitch Total Sq. Ft of Construction: /✓/ a Sq. Ft. of First Floor: /t/jn Cost of Construction: $ %%cl S Utilities: Sewer Septic Building Height: Name p Address: !� F�%.�dV�S:, ��9� City: f22T }1 �i� C FG State: Zip Code: %= .. . „� u;FaX a.� .. Name`' s 1, Com�ny:r.,js Q•/-ZG�GT/Z!C *•r -- r. Addrdss1 _.Z fi�btZ /Z, City: V 6442 fgc'9 CH State: 't C Phone No. Zip Code: ?7—!?6 0 Fax: E-Mail: Fill in fee simple Title Holder on, next page ( if different from the Owner listed above) i Phone No Z - 66 -Z-.15 E-Mail 6" CGS/ CPM (' j,5 , /(&?- State or County License 45CISC7 Or. a a If value of cons i ruction is 2500 or more, a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: Not Applicable Name: Addressw,. City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: X Not Applicable MORTGAGE COMPANY: _V Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: Name:_ Addressi Address: City: I City:_ Zip:. i Phone: 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 Association 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. I �J • -mil. 9nb-822 Signature'of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE O,F FLORID 911� `I STATE OF FLORIDA ,� COUNTY OF oyJ�it�O�/lWA, %ek;A&L iA COUNTY OF The forPP��i,,.ng instrument as acknowledged before me 20�by The for ing instrum nt w s acknowledged before me this May of IIII this ay of 2021by Name of person making statement. Name of person making statement. Personally Known t/ OR Produced Identification Personally Known '� OR Produced Identification Type of Identification Type of Identification Produced! Produced (Signature of Nota ublic- St of F o ' (Signature of Notary'Public- StaA of Florida ) ''+ �A,"" WILI.IAMSURGEON Commission No. OMMISSIt 136489 Comm sib ,. WILI'AMSURGEON S I) EXPIRES: August 28, 2021 •krxiii- .A00— ; MY COMMISSION # GG 136489 '��1 • off: .• .•<: eandedThruNct, ry Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLAN MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Kev. 8/2/