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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: !& Permit Number: 1(o C� RECEIVED JAN 13 2016 Building Permit Application Planning and Development Services Building and Code Regulation Division P 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: 1 e c}`; PR®POSED IN;PR�®UEMENT LOCATION: Address: 0 Zy r+-e. f' L a n. P Legal Description: Property Tax ID#: 1 x 1 - 1 1 - 8 a' O 5 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE�SC811!PTIONF WORK: C' G v/i*,e c new 6 (iC.,r 1Q A-S GonireC- CONSTRUCTI��N 1'NFORMATION: 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: $ OO Utilities: —Sewer —Septic Building Height: OW;N�ERf LE�S�S.EaE: CONI'RAC7'®R; 1' Name 2lL'f'O/1 Name: �^1�(LT HAM 4: : Address . G o z.�n. .t �--a n e Company: /+ j f City:�"o r+ S-• Ly.i pState: FL. Address: ISIS SF_ S�n 611Al P Zip Code: I"(`1.6'2 Fax: City: Po S 4-. LStater Phone No. S 7 ' 6 3 Z ' 950 3 Zip Code: 3 cf�! SZ Fax: E-Mail: Phone No 7 2- - G 6 Fill in fee simple Title Holder on next page(if different E-Mail o- (en e,I ac.fr;ca &rove co from the Owner listed above) State or County License FG (.30664(5/� If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S PPLEMENTAL C©NSA =10CATHAMIN' EN LAW INFORMA 10N: 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 Not' of Commencement. Signature f wner/Lessee/Con trac r as Agent for Owner Signatur/oftractor/Licen�seder COUNTY OF ST F ORIDJSTA�Jc CO T TY OFRIDA The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me this "� day of 3.,k" 201 by this \3 day of 20X5p� by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary P lic-State of Florida) (Signature of Notary blit-State of Florida) Personally Known OR Produced Id '.c-at"ro �� Personally Known ORP odu e .l Qntf> atrofY'®' Type of Identification p�AN�A s,ate01 F1occ�j6` Type of Identificatjai DEANNA GIVENS Produced �-L l.. Public �6, Produced Pti �,,,,,,� ay s0ec 2� ©;-, r Public State of Florida E,q\t 85676A My Comm.Expires Dec 16,2016 = Gom a'{: #6zl sus Commission No. a ommiss.0 Commission No. MY D, si°°zGo Notacy P , � F558761 n �( e otar iti • ,, ', �_ ;hFou9h ' "%.F o��<' 6onded Through tvaliona Y Assn J /'S.grE OF"O�• U° J (� '.pyo; ..:9"sY .. _i REVIEWS FRON ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014