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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICA 7LE INFO MUST BE COMPLF - -: 'FOR APPLICATION TO BE ACCEPTED Date: r permit Number: i 503' d 53 3 RECEIVE© MAR 3 0 2015 SCANNED -- --- Building Permit Application BY St. Lucie Countv Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 1>"� Residential PERMIT APPLICATION FOR: PROPOSED INPROUEMENTAALOCATION: Address: _.�_%g% ..5, yi Z Legal Description: d PropertyTaxlDtl: 'sib �ta> -away-aod n Lot No. Site Plan Name: Block No. Project Name: �77ie� .S�o✓ { Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: De-),±e unoece55-oy 7-ai574ndord GoAda;t q&21 r^ece 422aWlES 1­.Vcq&f le boxes aAd devices �ori'A CONSTRUCTION INFORMAiTION: Additional work to be pertormea un ert is permit- check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors' _ Electric _ Plumbing _Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: Sq Ft. of First Floor: Cost of Construction: $ k060 . a O Utiliti ,., r _ Septic Building Height: OWNER AMUZ-EE: CONTR CTOR: Name L:r4. �eYr;P �._ Naine:'AJJPyiosec7<r:c �enfinc�a�c Sc Address:'6-,70 i?.;'!%S1 V t Com an :_ e �O,' p y Svfd City: ,f %tier �,•` '� Stater Address: V11. a,w City:orfi >yeire Stater Zip Code: Fax: Phone No. aa0 — 698 Zip Code: 3l/9 "'�� Fax: 2fGS-aaSS- E-Mail: Phone No 370- is7O Fill in fee simple Title Holder on next page (if different E-Mail c714 rs n ± cb )/,74'y .cam State or County License 227 000-272 5— from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONST iIO LIEN LAW INFORMATIO DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE-SIMPLETITLE HOLDER: _ Not Applicable Name: 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 recording your Notice of Commencement. Signat r, `of caner/ essee/Agent Signatur o o ractor/ 'license Holder ` STATE OF FLORIDA STATE OF FLORA COUNTY OF S k. ti u e COUNTY OF The forgoing instrument %�vvas acknowledged before me The forgoing instrument was acknowledged before me �M0.r_ this30 dayof tR0.cct\ 20 %5 by this"30 dayof 201_S by -3"- fkfRA 7 R.-4f-9`1 'V V%C5 Sa y\ (Name of person acknowledging) (Name of person acknowledgin ) (Signature of Notary Pr lic-State of Florida) (Signature of Notary Public -State of Florida) Personally Known OR Produced Ide pti �e[L ° ,a?fi rsonally Known OR Produced Identification Type of 9Q°\E*o`�°�efi`y STroducee of ldentific'tio�n _ Produelddentific`tiT)L Sao° OEpNNpS�'�0f`D2a Q%sVir • 0eG 1fi. °t°t°' `\p°a� ,.mp�eic°•. VG mra �"S �Na Commission No. �54 {�'eatp Corri'm n No. j=� •'cu"e"o, N `y Ex9%tes E115 '� ..;M a,,k -=°P C mtsst„N#oatNO�atY REVIEWS FRONT G S41PERVISOR PLANS VEGETATION LE, MANGROVE t COUNTER EVIEW REVIEW REVIEW REVIEW REVIEW - REVIEW DATE RECEIVED DATE COMPLETED �1� Kev. //ZU14