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HomeMy WebLinkAboutBuilding Permit Application 1� I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: il(O -053 I 13;-.&`3 i ISI 1 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: 49_ RZ,I ® INPROlEM"E `T LCICATI'0'N: Address: Iy! i Legal Description: Property Tax ID#: ?4'Z') C,C)3 C72�t00L-) - 5 Lot No. Site Plan Name: Block No. Project Name: i Setbacks Front Back: Right Side: Left Side: DETA.LED © �SCRt' .h0'N Of U1/OR?_ r �! Y2-e_4I.�CP ro J'-1 rd ;I C®NSA RUCTION I=NFO'RMATI,ON; Additional wor to be performed under this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors V/Electric —Plumbing _Sprinklers —Generator j _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: S AZ Dp Utilities: —Sewer _Septic ' Building Height: c �ON�ER/LEfS'SE�E: ' CON,�TiI;�.C�OR: Name 1 ri emm erz, Name: Address: 3) '-15 10AYL15e, Q'(' Company: f'. Leri r et"ge- dle'✓ vet i4�2 City: ��Or —I t .P rG _State: Ft, Address: I©�-t 4 J U 1114, Zip Code: 34 g G=Z Fax: City: pot-,T 07 [AJI.E-e 1 State: F Phone No. 7 - 100'? '" /���92 5- Zip Code: 3CA di °S _ Fax: E-Mail: E .5�.•�ri�.f _ e l��n-AiL• GOA, Phone No 4-1, 1 Fill in fee simple Title Holder on next page (if different E-Mail LC,�., YNSeay�c� �rtiJi�} IL . C� from the Owner listed above) State or County License( If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. !,i SUPPtEML N.' C®NS�TRIJCTION LI N LAW.INFORn/LATIO:N: t�� On } 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 Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contr (r/License Holder STATE OF FLORIDA �-1� STATE OF FLORIDA COUNTY OF �'C tc. �l. COUNTY OF i,"J The forgoing instru ent was acknowledged before me The fo oing Inst ument was acknowledged before me thisr � day of�u,A 20� by thi day of� ��20L by (Name of person acknowledging) ( e of person acknowledging) ( gna re of Notary Publi to of Florida ) nature of Notary Public-Stat f Florida ) Personally Known OR Produced Identification Personally Know OR Produced Identification Type of Identification Type of Identification Produced oduced LASHAHNA INGRAM ;o<aRY�Ge.,� LASHAHNA NGRAM Commission No. cU`P0. ,ef� I��t��l�ublic-State of Florid r: mmission No. ?2.° •°= Notary Pub5e* to of Florida. My Comm.Expires Dec 20,20 8 NAM *Q; My Comm.Expires Dec 20,2018 N,• `�:= Commission#FF 177249 's9�F F%01" Commission Commissio Bonded 11 rough Nat,1 rial 1,10171Y � onded through Natic nal Notar REVIEWS FRONT "ZONING SUPERVISOR PLANS VEGETATION E TIiR L ` E COUNTER REVIEW REVIEW 'REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014