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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� Date: Permit Number: a a Elm 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: :t PROPOSED INPROUE ENT LOCATION � k t '' 4"� AilT1'§; ..lkk' xk4:-`d �l,'..La ..ASCr.'N Address: '/v '� Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �. .� :t..t. ...y al { r. DETAI ED'DESE PTION OF WORK �, ,v ..'s``7' .,4,. •� `S o �� i� a. Add iti nal work to be performed under this permit-CheCK all that appy: echanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$_ ��� ©� Utilities: _Sewer _Septic Building Height: DINNER LESSEE ' y``=h rr F= CONTRACTOR �}h: k ' ri '41F7, Name Name: AddrJ ®(� Company: Xz7f City: State:KL Addre s:l Zip Code: 9 UO Fax: City: State: Phone No`'_AR & %l 2 Zip Code: Fax: E-Mail: Phone No. - �" �� Fill in fee simple Title Holder on next page (if different E- Rjt .J from the Owner listed above) State ounty License: if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. a1tAr '�-- 3L 3 534 SUPPLEMENTAL CONSTRU7t tON �tEN LA1tU tNFQRMATION 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 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/Agent/Lessee Signature of Contractor/License Holder STATE OF FLORIDA 1 STATE OF FLORIDA COUNTY OF COUNTY OF -�•.1e„Q The f going instr ent was acknowledged before me The f oing instrum t was acknowledged before me this day of 201 by this day of 201] by (Name of p son acknowledging) (Name of person acknowledging) ign ture of Notary Publi State of Florida) \ gn ture of Notary Public-Sta6 of Florida) Personally Known OR Produced Identificationy Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Co mms issionNo.C-3��.((�0 (Seal) (Seal) Commission No. �plurrp/ PPAWAIA iAi..,-,. fel_—„pllll^r,r - .=1, Notary. ublic state of Flori la `� ,����` �'= Notary;= oiic\state of REVIEWS FRONT °�� I- G Com.aSI,1RrE�V�S�RZ 18 ti'LANS VEGETAT�IO� f SE/ 10(RTiLE Ex irMJkNGROVEi` COUNT `VIEW Com issiRE�{/VE /7249 REVIEW REVIEVI� ':',f REVIEWimissio i#REIVffW r, Of F.,�� it F P OF r10 . DATE ' t a icna Notary As^n.PI �' � rouyn r ahonal Notary �� >:.= — Assr RECEIVED "`` `�.%-•;,.-.. ^� .�=c- ;�_ DATE COMPLETED Rev.7/2014