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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: g Permit Number: l 5d 1-01 a l RECEIVED SEP 0 81015 r_ 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: DI � 1 abt� JE111P1..FCAT'w2'YIM1'kG, .g now oL� _ Address: 1N1 ICI LJ J /6,eT P1/6,e egcic Legal Description: 1M, ` d WA k<A LOTS 10 J f 14 AW Property Tax ID#: 3103 ©C) / •- on (f>m Lot No. IG Site Plan Name: Block No. Project Name: -- 7_0 C.?) i i Setbacks Front Back: Right Side: Left Side: 9— ! VI UC0JD W A Nc A S P&AC E slo'b f� C ,SSA R11°CC1Ni®RM.��.,, i h10N GP� Additional work to be perto�r`mecl under tispermft—cherk r . a that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq.Ti of Construction: - Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer —Septic Building Height: F , "".{"'x-r;z�.7 ; "' f s�.�, ° _ _ :i- �+..�.i a '3 wr!,11 1 `z. OUxER/LESSE{ � p �k CONTRA R° _ �� e0. x � . .. �i '.0 m i �,� � z;Yw�. �,, x Name A 1J S i Na d Address: ] Y14'' I'J W Ay 'QC1 Company: �' 4bLL) City: C:4aT /ve ��� State:& Address: Zip Code: Fax: City: 9 State: Phone No. ' A Zip Code: ` L/ 9 q X -Fa .C� E-Mail: -Moo o CO Phone No 6 �3O Fill in fee simple Title Holder on next page (if different E-Mail /-/A b tn,, 2-/A a(6 K-A from the Owner listed above) State or County License Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required. 160�� 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 opxC!qording your Notice of Commencement. Signature of Owner ssee/Agent Signature oCon /License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 5 k . Lyc COUNTY OF -!�A_ Lt)c\sZ The fgrgoing instrumentwas acknowledged before me The f going insti mei t was acknowledgQ before me this day of 20 15 by this day of 20_ by - `� t a.•rte � Q-t �n�t��e� ����.Z �.t A,rte. 'fir�.��g r a C,2 ��d,Z (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pub' -State of Florida) (Signature of Notary lic-State of Florida) Personally Known: OR Pr � �gpit�iea rod oc-da Personally Known OR Produced i 'qctrn_'\N_ Type of Identifi atio Pnb\ic Stateec 16 tot Type of Identification DEPN�N State n ,6 2� Produced t- °Pa°P�e�., Nota�Y m ExPlSes� g5a"16,- Produced 1, p 1— �bUc'\tesDec y9lb �omm%ss\on EE Notary Assn. Not m ExP #EE9 ty pss , nal Commission No. ' t- +l gonde6�eaP hNaUo Commission No. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO EA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.