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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' 1 Date: la �, f! Permit Number: s RECELVEo ,RANI • By BuildingPermit Application DEC 2 7P0§t. Lucie C pp Permitting cep Planning uilding and ode Regulation Division St' LUe1e co"untyegt B 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line re - :PROPOSED IMPROVEMENT LOCATION: G Address U 00 c3 S • 1 r1 M 1 a (1 ttWi DQ • ` o,-+--f -e rce_ Jq I ra Legal Description:Oooj ens S/D 1,91- ag LJ4 P of t-L` 2!w _of FrC. 02 -LfsS d r;74 Oed I eS.9 Rb R/ia -C3.90 AC) (oQ &64-a9y'a:36r1I-d341) Property Tax ID ff: SN 0 L - r 70I -Ocx�)to - CCD -L-( Lot No. 076 Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION'OF WORK 2en-r-c� -ei/AS4�n9 rooF SgS4-cr.r1 ds-,:�n Fo Plywood rY_Ala-;! 4-0 Coct-c- Inst-ctu 3o//0 4-al- Paper- to C-oPU. (ns{ctt( -TimK�-Heri iAR e Mphik+ Shingly r�F�S�ti�. !o a, E . -ex-i, 4-; nj 'Pa-4 ro% d(u Y• b p1q. Q,5,j , 1 to cello .err ta! ram or d (�' loi � Vet � �>•— apPl � ecf rn od.� v -vLrn.en . ,CONSTRUCTION INFORMATION: OHVAC u Gas Tank ❑Gas Pi 11 Electric 0 Plumbing OSprinl Total Sq. Ft of Construction: rd 4 %-�i Cost of Construction: $ 6), yVZ3- — ing UShutters ❑Windows/Doors °rs Generator _ Roof © Roof pitch S Ft. of First Floor: �b UtilitiestSewer 0Septic Building Height: OWNERAESSEE•r CONTRACTOR: Name -re Karl XeA 6ronk Trwsf- . 4PLb rrtSl ek Name: (' rf 0. _ Address:L� 3.1ndi4n /%, Air FOR- TruS+w Company: u '� <yt-i nj City: -1-0r4 PIYrCe State: Zip Code: 3Lfqr,;, Fax: Phone No. r1'1;L - L1 rj Cj Address: ly)AG.t-,�) v,4 - City: fk4- S-1- &AAC e. Zip Code: 3 Lta &-I Fax: Phone No. r1178-3til`--r7lV5 State:_4�, r?7a-aor?-r13S1 E-Mail: 1'y\A0IGlou 3 (G6auI-C-,v Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail: S 4-1 is a}f r 0Ci t1@) a hoo . 0_3`N\ State or County License: CCC (' Oft 1p it va.ue or construction is >z)uu or more, a utcoaoEU notice of commencement is required. SUPPLfMEfVTAL'CONSTRU,CTION . , LIEN4 CAW'INFORMATION :.. DESIGNER/ENGINEER: Name: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: Zip: Phone State: City: State: Zip: Phone: FEE SIMPLE TITLEHOLDER: _ Name: Not Applicable BONDING COMPANY: _Not Applicable Name: Address: Address: City: City: Zip: 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 commencine work or recordine vour Notice of Commencement. Signature of Ow er essee/Contractor as Agent for Owner Signature ontractor/License Holder STATE OF FL J COUNTY OFORIDASTATE OF FL COUNTY OF ORIDA�� 1A The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me this 1 day of DPC 20by this__ffdayof bfG 20j-&'by J e,- Ala rnos�''�- Name of petsoA making state ent Name of p`on_making statement Personally Known _AGOR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced CDC p'U� /,- (Signature of Notary Public- tate of Florida) (Signature of Notary Public- Itate of Florida ) Commission No. 2722 C NSTA CE PROULX^V' Commission N (Seal) at".,,, P`w N' state 0 Florida-Notery Public ,,, CONS TANCE PROULX °k=State C5 E• •`- Commlealon A GG 258328 11 _� of Flori Imy ommi art . 2022 -''.?�..a� k� GG 2 s�ioyng y � qM9yf° 8328 REVIEWS R PLANS V N &Ex 4Vl AN ROVE REVIEW REVIEW REVIEW RE 2 22 EW DATE RECEIVED DATE COMPLETED Rev. 8/2/17