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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: F SCABNNE APR 2 9 2016 Building Permit ApplicAi6W Ie County Public Works Planning and Development Services St. Lucie County, FL Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FI,34982 - Phone: (772) 4624553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III PROPOSED IMPROVEMENT LOCATION: Ala Address: © c��- LVC,LC(1_iF1 3y5 S7 Legal Description: fr>n Ul t cry �'r, n� w/ q G8 " C? G C2-+rr, r Property Tax ID#: S,-I,1 L(bD( 1916-- (Go( Site Plan Name: - Project Name: Setbacks Front Back: Right Side: Left Side: Lot No. Block No. DETAILED DESCRIPTION OF WORK: /�� rr�� VtS ��Ct Q(V(/\G✓\.GS �I A-giAC cow%p r�v`I r� Ct. G J l 1Ni-- -Z(e-UkY v% CONSTRUCTION INFORMATION - al worK to e e rme under tispermit-checka apply: ❑HVAC n Gas Tank ❑Gas Piping _ Shutters a Windows/Doors ElElectric 0 Plumbing []Sprinklers El Generator D Roof Total Sq. Ft of Construction: S Ft. of First Floor: G Gt7 Cost of Construction: $ o� 1 .. Utilities: _Sewer E]Septic Building Height: OWNER/LESSEE: CONTRACTOR: , . Name It 9AM Name:- �tQt4, I,Ioutiy-. I� Address: Pt�t hhrcl. S� 1160 Company: jt�� City: /. 41 nn��. State: Zip Code 303 0 Fax: Phone N 70 ^� i 4 Address: City: DGL& �3ry , State:� Zip Code: __ .22, "I Fax: Phone (. E-Mail: b' I JA f , C.. Fill in fee simple Title Holder on next page (if different from the owner listed above ) ,,'��`�%l E-Mail:may l (.m_mM - } . S o State or County License: ty S13G- If value of construction is $2500 or more, 6 RECORDED Notice of Commencement is required. - SUPPLEMENTAL CONSTRUCTION LIEN WV"WiJAMA11 N . '•.. 1 ' DESIGNER NGIN� EEER:. p!otApplicable.......- MORTGAGE COMPANY:_ Not Applicable . Name:GIC\ - a,n,;':. Name:_ Address: o Address:: City:. " r Staff " City: Stater ' s Zip: Phone: tf0 Zip: " s `. Phone> `�".' � PEE SIMPLE TITLE HOLDER:. at Appiicali`l G®NDING COMPANY: _Not Applicable ;` Name: ;, ,... .....Name: Address: _ _ 7 Address: City.. City: Zip: Phone: Zip: Phone: I certify that no work or installation has cd'mmenced pit FAo theViss6ance of a permif.:: St. Lucie County mates no representation what is granting a ppermitwill authorize the permit holder to build the subject structure • ; is in with applicable Home Owners Associatiop rules,bylaws or and covenants that may restrict or prohibit such ' - which conflict any 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; ferrFes, wails, signs, screen rooms and accessory uses to another non-residential use : WARNING TO OWNER:.Your frailure to Record a Ncit'a'ce'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 th ' first inspection. If u Trend to obt in financing; consult with lender or an attorney before 'ommeneement. com worl(or reco our Notice of _.S ' _ Si of Owner/ Le see/Agent signatureof Contrac or/License Holder ' STATE OF FLORIDLI / STATE OF FLORI OF COUNTY OF 1/dlr/flffy _ COUNTY Thefor instru ent was acknowledged before me The fo�ng instrument was acknowledged before me `this5 20by ' - ' this�'""'8ayZO!by _ day of-)`f`"'` .. •• .' vet. -mj (w l&,,7 VKA �� C, n l kh V (Name of person acknowledging) .. -) (Name of person acknowledging) - - (Signature of Notary Pu Late of Ff loribla) '� "-'I r.(Signature of Notary Publi tate of Florida )_ Personally Known OR.Produ edl entificationr, -! ; L,MCLAU Personally Known � OR r#ur,;etl�7e MWAW at" 26�22' -" +`�:t+�-yBt'""ia MiG-lfl._-.. Type of Identifica on.p�y�,�ced�� � a ON 7"ype of Identification Produced\� : "- MY COMMiSS— I1!FF' EXPIRES Septereket„ , 1B I; • , Commission No. Y COMI,tr�ON #FF782822No."' [r Commission 01I 39B-0Ipveali FloriOallorary$eNice' 1�A..... cV010CC a66mmMr01 �JA1a ' Revised 07/]5/2014 -REVIEWS FRONT• •^: 20NIQ1 SUPERVISOR— I -PLANS " VEGETATION SEATURTLE. MANGR6VE , COUNTER REVIEW; REV iE_TQicmlo(EWt/I "" 44EV(EW" -REVIEW REVIEW;' DATE ur Itstss.l' f . •, . COMPLETE s/ -- INITIALS on ��: r•2T, Sr;ry la rttg ut,rn