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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBack: Right Side: Left Side: Lot No._ Block No. All APPLICABLE INFO OOyMUST BcEtCOMPLEI�___,'FOR APPLICATION TO BE ACCEPTED Date: — `% / 7 SCANNED Permit Number: I `�d \ — Gi4 I fl BY St. Lucie County Building Permit Application 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 Residential PERMIT APPLICATION FOR: Address: -Z 'i %S C�,Q S he—w L—^ • l+ Et` I" i".Q/_e42�f C' a 3 Legal Description: Property Tax ID #: Site Plan Name: _ Project Name: Setbacks Front ty -3�-. C1le-5-r` V✓177 f zviPo4— /- Additional work to be pertormed under this permit— check all that apply: _Mechanical _ Gas Tank - Gas Piping _ Shutters — Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _,.Roof Total Sq. Ft of Constructio�nq ©� Sq. Ft. of First Floor: Cost of Construction: $ 5 Utilities: Sewer _ Septic Building Height: OWNER/LE�S�SEE: CQNTRACTQR�. Name' a�c/2rg � ijj 2 U�/nV,(4l T7�.25 Name: c�Q Address: 3 oe� �• vn4,p% -WJ " 5,4� �p co anti p y:, R. .� 5- 2G Frnc-q Address: City; r rtn«/�bl M State: MT Zip Code: �/d40 9 Fax: Phone No. y-O City: Nq±�J 57M zgc(i` State: f:::*L Zip Code(6 eT -Fax: (.3") Lf�3—mac Phone No.(3,&s,) & g' _ 79RA. E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail: rey (r w S' 6'/17W4COO lco, Co(?l State or County License: `R 13 C) / If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMIIUFORMATION: DESIGNER/ENGINEER:' _ Not Applicable Name: Address: City: State: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: BONDING COMPANY: Not Applicable Name: Address: City: 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 vour Notice of Commencement. SieatCre of Ovdher/ Agent/ Lessee I Signature of Contractor/License Holder STATE OF FLOFI�I A STATE OF FLORIDA COUNTY OF S. L Q COUNTY OF 34. LUr The fo going instrument was acknowledged before me The forgoing instru ent was acknowledged before me this V\ day of k 20� by this A day of P"h 2JN by Cr IZ5 -V k IN k IV\ 6 r ! P n IN Sir (Name of person acknowledging) (Name of person a knowledging ) (Signature of Notary Publi'- State of Florida) (Signature of Notary PuNc- State of Florida ) Personally Known OR Produced Identifi Personally Known OR Produced Iden Type of Identification Produced L Q NS � a Type of Identification Produce 1� %o 60111 d _ N�1P a 01 ��6 a 11C • 16 � pEP S�a�, �6.2 �P Notaty Pub Tres Dec 16.20 Commission No. 1n-�� 1 o Q(s+�afs g16 p Commission No. ��� `��: MY dale on # EE 858Y61 sn. LGcoo sop # Nolaly SnP c • oe` Gom hrouar National tint REVIEWS FR h[`(• 0 `� SUPERVISOR PLANS VEGETATIO " "' EA TURTLE MANGROVE COU re EW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE q COMPLETED