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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:T\ rJ Permit Number: I Sa�J 5q RECE)t.`77D AUG 11101 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: Fib" C�9- PRQPOSED I'N R©VEMENT LCAT ONIl: Address: 2` D V1 l t_7 �aoSo W tarp Legal Description: RtU� PG( �c 1J�1 ry RIC (��j �.0 1l� Property Tax ID#: 3q 19- 55-5 iJ ' 6016 - boo-5 Lot No. Site.Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DEl'AILED DE�SCR9IPTION OE WORK; Y-COW q-px ` I', oeG-c ;vie anox 0OfT t5A iw 0-00" rAu(A 'its -<'20X- QSR 14 NTUL © Additional work to be pertormed under tis permit-check all that 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:$ 1 JQQ Utilities: —Sewer —Septic Building Height: OW�'NER/LE�SSE�E: �ONiTRA h AOR: Name �i i o- �� C``.p t't2isi' Nam&" '_.a�2,T .�-�N►OSc3� S Addressp�`� '�`'' 'L21T►G Company City: ;_ L State:: .. Addr..ess: '.1_ra-Z-_SIa�1--V-ru Zip Code: 3 3 Fax: City: s L State: Phone No. 'I� �i 13-1 7((�� Zip Code: 3�.�V_3LA Fax: ZcS1 '19$W E-Mail: Phone No '"Z'12 336'1,134 Fill in fee simple Title Holder on next page(if different E-MailuJkawt.& 0 aj"W,G®'A from the Owner listed above) State or County License 2_52i;1 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Sl1PPLEMENTAL CaNSTRa1CTtON LIEN �Ul/ INF®RMATIQN: 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 our Notice of Commencement. ap /J1_ Signature of n4 /L see/Agent Signature of Co actor/ ense Holder STATE OF FLORIDA -STATE OF FLORIDA , COUNTY OF Sa-t ting ( -0elg., COUNTY OF �, �.JCL._ The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this A-day of k)qL14 20 IS by this_JL day of AL-4 Lxf 20� by 1l 1_4k_%_ e P '- `C� 7� Nom_ ► �-4/Vh (Name of person acknowledging) (Name of person acknowledging) Pl (Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida) Personally Known v OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification . Produced :�`•'�" ;: SHANE R pE �if o u ed = is SHANE R PENp �^ :~ MY CO�fISSION a�F y% '= MY COM✓1ftSSp�it FFZpy Commission No. 1`T 2t� 83 .`,, al Xp�ES Ferry 2 t scion No. oZ ,� �� Ex")Febrw 2A,X19 5.1 .oG� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.