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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Ia I I" t I I S Permit Number: 1 19O a" 6306 RECENED Planning and Development Services Building Permit Application �f RUC/e001A FEB 131010 Building and Code Regulation Division rmitting Department g St. Lucie Countv 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 I PROPOSED IMPROVEMENT LOCATION: Address: 91ono 5 . QCImn-prlvP.—unj) ma Legal Description: F_M rPS"', C'Q Xi(`ii"S inj lin unl+- 10a PropertyTaxlD#: Lot No. Site Plan Name Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: Move Qnck replace (a) Acin-1m-pcuci- SGV S. CustorncY hO exisfiing 5hU+1erS per mi+ #- I?1I-00bI CONSTRUCTION INFORMATION: Itiona wor to e e orme un er t is permit- check a apply: �HVAC MGasTank []GasPiping_Shutters Windows/Doors OElectric 0 Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ -I I Q(M' 00 Utilities:liSewer E]Septic Building Height: OWNER/LESSEE: _, > _ CONTRACTOR: Name KQ.V'el') SP(1QIla ' Name: 66 I A�1" E- Address: a�c0 S . i�7te 1�_��Y , (,�I 7f�o� Company: ::[�e' (j{0 ` ' WbO eSSI OY I(II(_; City: - JenSen hfflQh State: L Zip Code: 3 15% Fax: 'NI rit Phone No. ?M-79a' 5723 Address: IAI\1 City: state: FL Zip Code: 34go7 Fax: -17a d�10-04�I Phone No. '1'7eR • aR la - lit} S9 E-Mail:_# or)l , CQr r) Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail: State or Lounty License: JCND3 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: ,FEE,SIMPLE_TITLE HOLDER: Name:" _ Not Applicable BONDING COMPANY: Name: _Not Applicable 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 reviewyour 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 rO as Agent for Owner I Signat0're of Contractor[License Holder STATE OF FLORIDA STATE OF FLORIDA I COUNTY OF H© y+f n COUNTY OF H av'+IEn The fQq{{going instrument was acknowledged before me The for oing instrument was acknowledged before me this IT dayofTg( e 20_ by this Xdayof ])00=ber .2oL by 7 ... Name of persoh pfaking statement Personally Known V OR Produced Identification Type of Identification Produced (Signature of o ary ,7MwGieta@iI3e0lda KELLY WIDMAN i°��Y P4e`�s Notar y� - State of Florida Commission No. 1( I� Commission # FF 929255 =9�,•' My Comm. Expires Oct 20, 2019 -bau ir[ L a Pro (Ae. Name of persSpomaking statement Personally Known V OR Produced Identification Type of Identification Produced (Signature of'Vary P •"""'"•. KELLY WIDMAN o•�r P4B.'•. Commission No. rr °; Notar0elfild - State of Florida ;• . . •3 Commission # FF 929255 My Comm. Expires Oct 20, 2019 REVIEWS FRONT EATURTANGRO I COUNTER I REVIEW I ZONINGS REVIEWUPERVISORI PLANS REVIEW I VEGETATION EVI WI S REV EWLE I MREVIEW Rev.8/2/17