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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: i/ /' Permit Number: r �;. `� fir:. �J - Building Permit Application Planning and Development Services Building and Code Regulation Division rs � 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROIOSE® INI'R®UEMEN L(7CT01 .' a + s Address: Legal Description: Property Tax ID -00 © r Lot No. Site Plan Name: Block No. Project Name: ( 5�►,rz.ATEC91 L Setbacks Front Back: Right Side: Left Side: , r - D-ETAI:LEDDESCR§IrPTION � �" ' �` # `i,,: h z aOFUVORK �, r P { �: -tea- ,;d '' 'c; �i' to .- "� `` ^4.A ��rY y 1'i C ``CO;NS1-RUCTION INE®RMATIOTIV µ ,,. r vEt;�t"ke r#�.xs r 6� '.�• '�u .fl,..,. 4 F �.® +qa Additionalwork to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Ou Sq. Ft. of First Floor: Cost of Construction:$ F60- 0o Utilities: —Sewer —Septic Building Height: OWNER/LESSEEfl �'f CONl"RACTOR ' `" ��r �� WN, Name gr, rA 0 r,)k � 1-�� Name: �Aq%A V- 1�Lr=G--Lq-k C. �l i Address �' 7:C / L1 Cir/ fC L SO / Company: �� VA44- i f Ii 1 City: � Q,' . `"` c State:�L Address: '2Sb t° Crr lUkt CVL a r,a NN _ \ Zip Code: .f I,' 66! Fax: City.,DP<A- State: -t— Phone Ngo. �'.jj-,T* ALS-6 -cf22q- G"ly3 Zip Code-3`��G 5-2L Fax:�3b,.-1�3'Y 77z E-Mail: 4)7 ,Y I� I/ Phone No -7-7 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County Licensee l--!>Qb g-S if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. StJ`PPLEIVIENTAL CONST UCTI�N Ll LAW INyF4RMA1'ION: 19 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 firs inspection. If you intend to obtain financing, consult with lender or an attorney before commencin . ork or recording our Notice of Commencement. , i ?!i�g�natufeeown&/Lessee/ 't S'gnatu e of Con ctor/ kens Holder STATE OF FLORID r STATE OF FLORID COUNTY OF COUNTY OF The forgoing instr Qe6nt was acknowledged-Wore me The forgoing inst ent�!as� acknowledged ore me this day of 20 by this day of iJ� 204 by /J C, (Name o p on no ed ing (Nai, rso Mno dging) (Signature of Notary Public-State of Flori a ) igr ature of Notary Public-State of Florida) Personally Knov-�� OR Produced Identification Personally Known .. OR Produced Identification Type of Identific "8"1-0 Type of Identificati nProduced N.,� Produced ���d! ' ', t?✓@fe! AW�MILON :a. •`�: DAWN Commission N' :=9' ; J� ' M Ypu811c• I E Commission No. �t_ * �' = rotary p,& 1LOIyE 11 I 1. na �0 n1R1,fXpire� 01 Florida %F ,..oa``P`:My CpmM.E p eslale of Florida r" `w ®All mrtlleelon E 22,2017 Commission Mar 22 201 alional Not y rough Nafi nal 7j REVIEWS FRONT ZO RVISOR PLANS VEGETATION SEA TUR E COUNTER REVIEW R IEW REVIEW REVIEW REVIEW R I DATE RECEIVED DATE COMPLETED ev.7/2014