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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: `�` 1 �S Permit Number: 150"1 -01 1 Co •11 2111UN RECEIV'-:D SEP 01015 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: CE PROP&SE@ INPROME EM1ENT L4CATI®N: Address: 2iM fiRiN }- VzsrA Legal Description: Property Tax ID#: rJ 5 d �1 -dQd —,S Lot No. Site Plan Name: Block No. 3D Project Name: Setbacks Front Back: Right Side: Left Side: DETAI'LE® DESCRIPTION OF WOR=K: NN.R-TRUCTtONI INF®RMATION: 161 1 Additional work to be pertormed 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: Sq. Ft.of First Floor: Cost of Construction:$ 'W Utilities:Utilities: _Sewer _Septic Building Height: IN OW}NERf LE�SS�EE: CONTRAC*T®R: Name &-I\)+ Q A0 91_(Af- Name: IIX- CDA Address`.'n4 fhl4A \JJM@JffiCompany: fif=ty lM COBS City: 5-i- LyCxc- State: Address"7165-50 1)JWAZ5 TeRR04cG Zip Code:24(Sok Fax: City: PCC S't, L_.,)c�=C State: rf Phone No.�"1��Q5�3 Zip Code: SL4CJ53 Fax: E-Mail: Phone No -7--�a985oSg0 Fill in fee simple Title Holder on next page(if different E-Mail ® GogAZL - Can from the Owner listed above) State or County License a1 y L if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTR+UCTI©N LI: N LAW INFORMATl4N: , 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 of 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. Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary.Public-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,Noa, (Seal), REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION . SEAT.URTLE <MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW"' REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/203.4 011 5 L�lVI�IT LONS�' IUU� L""IIAV�t 'N,:��E�MA Ga1�I � a- ' 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 accessoryuses 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 c9mpnencing work or recQrding your Notice of Commencement. _JL, ignature of Owner/Lessee/Agent ignature of Contra ctor/Liceri'se Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S-� . L-Q COUNTY OF S The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me I his Lk day of S e P A ,26\5 by this day of 20]5 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pu lic-_State of Florida) (Signature of Notary Public-State of Florida) F:,y: V��S onaa S Personally Known OR Produc �g@o1F� �e Personally Knq-, t� ida Type of Identification''' o`a�y eUb\\ P`es�e e5— � s Trode of uceld entificati 1PUB��,,, �yotary Puelic 1 esaQe�16 2016 Produced Comm\S E�\No�aclPs _=,r ExPn_#EE 955761 M9 mm Na��o �ommissio .onaldota'•y Assn• Commission No.clid. Commission No. �6ondedTbt 4 Opp gCin� .(r \, Il11111\\\\\ lulu\ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.