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HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICAB INF®r4uST BE OMPLETED FOR APPLICATION TO BE ACCEPTED �^ / I ®QcC-�� � Date: Permit.Number: � �-�4 BuildingPermit 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: . dro box �t;: _ -s � *.'`a rv.k, ;z�4 P'I.�07 OJ 1l I{Y•'I� � L3IMl 3 L dX 1,0, +rrk 1: A. `?.. .fin }'" 4� .'�' a�`,_h i(t3 ,.3x '' rx.Y t• '�1,.;r.r s_.vc' .,,..., Legal.Description: Property Tax ID#: c"E-�j"y ' Q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: r ,s, c < ..y ?r x. s rr-. F•a i $ } S - �" ';�' ,r'e' �DETAIt,EI�DES�RIPTIO� 7 rplU 3� - - - 4- C7 P c��, ✓t! 502 ► h 3 .tic ,* „x- a r 1 S:- >,,{��,� -t'�' Yea '°Sn .,,; R -73, r ' '. $� ts,n w�,> �, �' ` x cu.'.�� 3 ;iµ✓S� `,� fir: S? 1JCTtOI���lFOI�i�AT10�����< ��� E1ona Wor to e e orme un er t is permit—check all tm appy:: O HVAC Gas Tank E]Gas.Piping Shutters Q:W. indowsJDoors ❑Electric Plumbing Sprinklers 'Generator Roof Total Sq.Ft of Construction: SQ.Ft.of First Floor: Cost of Construction:$ j) t?•�© Utilities.0 Sewer Septic Building Height;, T1771" s a h w ' C311I1� SS E, f 1 h^tN $ Namei��G f l G t {' pa 1— Name. i,i-t/l C LOA:L "167ti Address:01069 � i t��D e_ 15JC� 1666 Company:—] I2' � C'��r`5l �1IZ �L�1yD177` 'I City: (if'ICP�1C�� .State: LL Address �L' s�i� ��� Zip Code:&R l Fax: Lfb-._ t-I IP2—`7.35 City: State: "�'t i��G Zip Code Fax:. '77 J3 ICA Phone No. 1417 i p t E-Mail: Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: t'rf C 06( 4Ag if value of construction is$2500 or more,a RECORDED Notice of Commencement'is required. '��[,�''. 'sy.r, s .k"� 7;., ,ti:i r°F *:� sk; t , .$d"EG:1k !!k h6: 1U-aI?. � { Pi rFs st �`" t. yfi L'�t'i 3 ° v'g'se+'''° '3., �. 4, & ',`r°a`. DESIGNER/ENGINEER-. Not Applicable ItORTC�AGE CCIIPANY' _. Notpllcable Name Game: Address: Address: City: State: City: _ State Phone „ Zip: Zips Phone:- FEE;SIMPLE TITLE HOLDER: �Not,Applicable BONDING COMPANY.-. ._r Not Applicable Dame: Name: . Address: Address: City . :City. Zip: Phone: Zip: Phone 1 certify that.no work or installationhas commenced prior to.the issuance of`a permit. St.Lucie County makes no representation that is granting;a permit wlll.authorize the permit.holder to build the'subjectstructure which is in conAct with any Applicable Home Owners Association rules,bylaws oran*d covenants that may"restrict or prohibit such structure.Please consult with your Home Owners Association.and review your deed for:any restrictions.vuhrch 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,theFlorida-Building Codes and Si: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-resilential;use WARNING TO OWNER:Your failure to Record:a Notice of Commencement. result in your paying Mice for improvements to your property.A Notice of Commencement must be recorded:andi posted oh;the jobsite before the first inspection. If you intend to obtain financing;consult vvith lender or an attorney before ...commencingwork.or recordingour Notice of Commencement. Sig re of Owner/Lessee/Agent ;Sighaturh of Cbritraetor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF -� i COUNTY®F. The forgoing instrume t was a knowledged b fore me The forgoing instrument was acknowledged before me: this day of , �i't"P1pt l';20 by this day of'AlgW5 _ .20 , by (Name of person acknowledging-) (Name of person acknoWledging j _Ngrififui&-o otary Public=State of Florida j (Sig a of N Lary Public-state ofFlonda}. Personally Known OR Produced Identification Personally Known' MP,roduced Identification Type of Identification Produced Type of Identification Pro RTA r p� $'T DAMS Commission No. Commission No... ,;°}, °® t^; J ADAMS s co n FF907740 w4 «- Commission#FF 907740 �� orTT'co MY�om;missirt p .;ExR+yes Mv rAmmigginn S-*- I: r. Januar Jonuar.y 14T 20,17 t!lkF45tT .. Revised 07/15/201 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MAN ISR Q1lE COUNTER REVIEW REVIEW REVIEW REVIEW :REVIEW REVIEW ' DATE COMPLETE INITIALS