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HomeMy WebLinkAboutBuilding Permit Application i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 1`� 6N 1.6 Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 V Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential v— PERMIT APPLICATION FOR: 1 PROP©SED IiNPRO EMENT L®CAT11,M, Address: S /tat l t'4 Legal Description: /�l� �PJu' � /�� /�/oc� /'/-q 6:224.27 A6!Leg i31 Property Tax ID 0/Y.2 Lot No. Site Plan Name: / Block.No. ZqY Project Name: � //A4 l 7-Air0/ Setbacks Front Back: . Right Side: Left Side: DETAILED D@SCRIPTION OF OR! �s r CONSTRUCTION IN1F®RIMATP S Additional work to be pertormed under this permit—check all that appy: ; _Mechanical _Gas Tank _Gas Piping _Shutters i Windows/Doors Electric _Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: I' . Cost of Construction:$ /'2®� "� Utilities: _Sewer _Septic Building Height: OWNER LESSE "Co ,NT d RA OR. Name .., '����! :7— Ar.,/�I Name: l� ,5r Address: _7./G'S /' a� �Y, Company: F/,.,-�� City: A.& >��r�, State: Address: ,eZ?'Ve Zip Code: Fax: City: State: Fz Phone No. Zip Code: Fax: E-Mail: Phone No 2 7—�' �-"s Fill in fee simple Title Holder on next page(if different E-Mail ii, -91C/1 rdf✓ s from the Owner listed above) State or County License 's IZ 15`ll If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. N II SUPF'LEMEN,TAL CONSTRUCTI'&!N LI'EIV LAW IN "®RgMATION: ' 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 o Owner/Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder STATE OF FLORIDk,, STATE OF FLORIDA COUNTY( ��, COUNTY OFt, The forgoing instrFient was cknowledged before me The forgoing ins7wnent w s acknowledged before me this �day of 20_0 by this day of 20ja by L (Name person acknowledging) (Name of pe on acknowledging) Nigptgturof Notary Public-Sta Florida) ( ' ur of Notary Public-Sta of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced p Com iptssion_No. (Seal) ommission No. } Ast+aHrvA I �� -ay3-�� �0 � - ti, ,,•a�'�ua Public State of FIa2018 SHAHNA INGRAM Notary s Dec 24. Y res' Public-State e " _`; .= ly ° ' ' FF 7 Notary 2 tg 4ssion# REVIEWS FRONT =_"" TZ 11'J N Com •S� ' LANS VE �rt� ��nalP°► OVE COUNT €W Com iss111t otary A sn VIEW R 'll✓ 'W' 0° REVIEW DATE Of ` on RECEIVED fy-N DATE COMPLETED ev. /2014