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HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ` � Permit Number: �a Building Permit Application APR 2. 1 2016 v Planning and Development Services TfwC�, Lucie County, FL and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: Am PtC)(?OSDCNROEM�N .00AIC► t.m. � K101 � , Address:< lo /� �Y Legal Description: Y21 L COI) NW_ f- 55_rdC� cPl)� -7 � l� • �) Property Tax ID#: y�, ©d fD Q Lot No._9 Site Plan Name: Block No.' s. - Project Name: Setbacks Front Back: Right Side: Left Side: DETAED DE��ORg1PlON�QF WCtRK�� � � + t �4.:� h u � � . +�A, �a CONSTRUCTI ( (lORIV�ATI(7N �, �� x < s ,.,.,,. . _ wC x.:3"c z s ,, D�.. s„.,a<r i.•�„s T :-, .�_ti ,.. ,..?�,�._'ms's....£,re".',,r.....-. a..$..,u.: Additional work to eperformed under tis permit-check all that apply: Mechanical _GasTank _Gas Piping _Shutters /WindoWs/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor- -)00- 00 loor: _ Cost of Construction:$ � L �� ®� Utilities: _Sewer _Septic Building Height: 01t1/IRLSfs� � �� FF, C �CCFNTtAT Name: b Art/1-6 th ItA-S A(ALt Address: 1 6�_ 7 t�- 'GVti►'U. I i V l� Company 6`AV16 N,S, State:L Address: j.yWyo; 2c a: ?vim /0L Zip Code: ® Fax: City: 44V f'L State:L Phone No. Zip Code:' 33 2, Fax: E-Mail: Phone No `5-9- 3 ct Fill in fee simple Title Holder on next page(if different E-Mail J✓►n �J_ ( ! �•• N1%T from the Owner listed above) State or County License G6e 05-i -1 1 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: 1�/N iy1 t:S Address: i 9 i,i NC 14 s -1' Address: City: FT. LAV,02-0- (I-LS State: Fl, City: State: Zip: 33 3 Q S Phone qsY- -)N-- gooy 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. 14 e Signature o Owner/Lessee/Contractor a ent for Owner Sig a 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 3 day of ,A" ,20 by this 13— day of l)'))YCk ,.20 by (Name of person acknowledging) (Name of pe son acknowledging) (Signature of Notary Public-State of Florida) / (Signature o o Public-State of Florida) Personally Known OR Produced Identification V Personally Known . . ctaee�-Ie+ i€+snflon Type of Identification / Type of ldentificati n�; "'' :: BEVERLY DIANE(MARSHALL Produced ; G nZ. -Irl Produced :'= MY COMMISSION IF EEi63��� %,►a���,,•• EXPIRES JanuarOrl,2017 Commission No. (407)396-0133 Commission No. y�gLIC ON STATE OF FLORIDA REVIEWS FRONT 90reslIMMOOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED lev.7/2014 l -