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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED > [� Date: l -/ Permit Number: RECEIVE® . MAY 19 2015 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 /r PERMIT APPLICATION FOR: Demi/•f;op? R,@:i ®SE© INRRO®UEMENl' LaCAl'I'OIV: Address:N3 Aleifees ! V c11n5en Ue-aGLi, 1r4, 3YY57 Legal Description: ;/lie#/2J ZS%41761 94-s• 6P Z 20Y7 Property Tax ID#: 1-15-0)- ' 5'01"1.2 yO -0iX-,2- Lot No. 105-3 Site Plan Name: A*"9/�%V Block No. Project Name:—4/94/0s 1053 Setbacks Front Back: Right Side: Left Side: DETi41LED DE�SCR{IPTION OF 1NOR$K: . lele e^ob?';on e&,l nezvavel of X6 : _ 6 . zookl dm CONSTR�tJCTIF®RMATIO'N: y n, 10"i r ,,Aoitional work to be pertormed under this permit-check all tat appy.:; 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: $ 170,9•oo Utilities: 'Sewer _Septic Building Height: 'Fo � , a ®Ur1NER L6171, E: C®NTRACT®R. . P. _ .c. _. Name a X e r i Name: il Address: /0-5-3 11141-If glvl Company: -�o�t Svc• "Ic. City: ,Tensz'h 94.w-4 State: Address: -file 54.2--er Zip Code: 3 y?5-7 Fax: City: Jin Seg '04&4e'12 State: FL. Phone No. 722- 7,12Y - 47d}9 Zip Code: J'/Z5 7 Fax:77,2-.2-3)-'�/9/ E-Mail: Phone No 77,2 - 2d'0 - ,371,7 / Fill in fee simple Title Holder on next page (if different E-Mail 4G�c,M,3/y+�Edi the C� Y4/�00 - �9hi from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. s r SIJPPLE11fiE'NTAjI. CONST'R+11C�1"I®N LIEN �i4W IN`F®'RIVIgTI'ON: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address:' Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: 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 commencing work or recording-your Notice of Commencement. Signature of Owner/Agent/Lessee/Contracto Signature of Contractor/License Holder STATE OF FLORIDArot` STATE OF FLO kD COUNTY OF �3l/� {\ G�iG� :SQA;;F: COUNTY OF � �� , 1GGbr� • The forgPing instrument was acknowledged be rie t ��,a The forgoing instrument was acknowledged before mermn o this�day of l r�� - 20 /J b ��9 this day of 5?Y14_ 20 by fe U �� (� z M -� i)PM ,� fT� �STS ? �l� (Name of person acknowledging) j (Name of person acknowledging) /I/➢l ��G� \ � � ��a��j��/ 6 a 4 .��/ �� �f�'71 i.Kl�/%�/�V' (Signatur�of Notary Public-State of Florida) Signature o✓. otary Pub ic-State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.