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HomeMy WebLinkAboutpermit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) n� Date: Permit Number:-/ 7 ~© � "r ER , . ��.>i.: k,c.�q•-pix` �.. p �� 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: PR®POSED IINPR®UEMENT' L® ATI®'N: Address: ` 3� S S,L--7,1_'—c-_ 1V477" GDcJ2l Legal Description: 3 z ��/2- Property Tax ID#: 9 �`/©- Q/�7. 0W0 Lot No. �Z Site Plan Name: Block No._ Z/7 Project Name: Setbacks Front Back: Right Side: Left Side: DETAIL�D Df�SCR� PTtON OF WORK: 2 CONSTRUCTIONI INI.', TION: Additional work to be pe orme ,un er this permit-c ec all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer- —Septic Building Height: OWN 621;S`6EE. INK N0=0 Name ��e`/1/L•�TL� Ov2 �lC Name: Address: l30 s� S -�Ni��' �!" Company: ��✓� City: 51J State:_ Address: ZG Z'-O LUG Gil�� Zip Code: 3 `7�9-3 Fax: s� City: r , ��cl�� G� State Phone No.��2 ZD / U 3 Zip Code:'--5 Fax: E-Mail: Phone No_ Fill in fee simple Title Holder on next page (if different - ail from the Owner listed above) State o County License Z3 4-10 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL C®NSTRt1"CTION LIEN LAIN INFCTR+MATLON,. 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 wopk. or recording our Notice of Commencement. Signaturr`df Owner/Lessee/Contractor as Agent for Owner Signa Contractor/License Holder STAT& F FLORIDA STA OF FLORIDA COUNTY OF COUNTY OF The f rgoing instrument was acknowledged before me The forgoing insrument was acknowledged before me this day of 4'e5b 20 Com' by this� day of �. 20 n by h�2t n (Name of person acknowledging) (Name of person acknowledging) Signature of Notary Public State of Florida) (Signature of Notary Public- tate of Florida) Personally Known OR.--Produced Identification Persona Ily'Known OR Produced Identification Type of � v,.,.. yp Identification t' ;:�,,H;";;�. w ""'^°�-f. T e of Identification F ,�,,,, ..� LASHANN7i iNGRAtr7 P duced `" 1 ASi37tlNA i���Ci3��A Produced ' �- Notary Publi .s -° °;'- °,�* My comm. c tate of Flo a ! :. , 'n = ublic-State of F7� Expires '` My Com rich Y, Commission No. rF 4a.,, Decbec 20,2 1 ti r es 4 FGo (S@Amission Commission Na ';9, a,. T$6vlx Dec 20,2ota — .,#;,,,,��' FF 177249 Camm'ssron 4 FF 177299 Bonded ihrou "''"" Bonded throe Ah National Not Asn r through National Noiar � ' a • ._._ YAssn r' REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.