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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 1 to I 1 I 0 (Dy Wi .. ; RECEIVE® Building Permit Application NOV /2 2016 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: Wn v =PROPCISEDINPR UEMEN�r OCATION. � i,= qhs,:. � ,� `y � � Address: 2-3 z. / .5a wl ;vqe C; FZ- 3l �2 Legal Description: Zl e i a e ohe Z6111? Property Tax ID#:� 31-196 703 w22- ODO-S' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: "vLime�#f4"Si de: Wi h _ pa �.i r' 4'eE�ni'ti. ,�'' '.!';#�.�4' # '`�✓�,:ki�.F "�«* u�.�'-�iR �"�'' NG' InClOo✓• rT- 14, 7cnx lessik` .a., 2 Gahe�PY e�rus 11000 _ %jC�,p00 10 t3 r . c9, LQ es PA/ 7A9A6z1 _ 44C d3SE00"0- 4S8 su1,6 d„DwnPr- "' ,: *� ' �r'.'�tlt'�.ax; "3+'-��N'���e .i "�"'�,�>•p�`""Pi����� ��ern ` �r W_ �����i��4,_�"., r'sG;_ ��:n � NSTRUCTION�INFORMATIflN �� Kt _ ;_� y "a3� � p � R Ii itiona :wor to a per orme un er t is permit-c ec a t atapp y: _Mechanical _Gas Tank _Gas Piping lShuttets _Windows/D(jors _Electric V Plumbing _Sprinklers _Generator _Roof Total Sq. Ft,of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Sr0, 0L0 Utilities: _Sewer _Septic Building Height: R -r W.” r � Name /err)( Name: 'llr�'x5rY �rR/ISy� .✓ Address: g .SC 00/P;Alc C i r- Company: (:!�' Plu ML r7e City: StateAddress: €'2 ff6 S 1 dn�©r� !� State: � Zip Code: City: � - State: Phone No. '772 6 a/ 95-5-9 Zip Code: 3 Fax: E-Mail: Phone No •772 /-//0 7344 Fill in fee simple Title Holder on next page (if different E-Mail (5W/urnk#i ;ne (: c0 m from the Owner listed above) State or County License CFC 11IM39 6 if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIJPPLEn/IENTAL CONSTRTl1CTION LIEN LAVU INFORIUTA�OWN MO. Ay _ 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 thepermit 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 firs inspection. If you intend to obtain financing, consult with lender or an attorney before commencin ork or recording our Notice of Commencement. i S' .n . _fy. ner�Lessee/ContractorasA Agent r' ''„*• �atu� _ g e[�;' Signature �o actor/License Holder " m STA OF FLORIDA ; m� STATE OF FLORIDA a��g COUNTY OF a��= COUNTY OF �0 m The for oing instr t was acknowledged before = The forgoing ins rument was acknowledged before w z this day of 20IiGby Z this day of t' V-- : 20 Comby T m Q if eras N Q le k,3e (Name of person ackn wledging) (Name of person acknow edging) aAu/-,- 6� - �41 (Signature of o ary Public-State of Flo da) U (Signature of Notar ublic-State of Florida ) Personally Know. OR Produced Identification Personally Known OR Produced Identification Type of Identificatio Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.