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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a Date: �- )�s—J �7 � Permit Number: � . 1 - BuildingPermit Application JUL 1.8 2017 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: j "; Address: �2 ( J `7 _442a&zQ"!J Legal Description: Property Tax ID#: o� — !— ©n C'C Lot No. Site Plan Name: Block No. Project Name: I d/A d4 Setbacks, Front Back: Right Side: Left Side: 0 52 ` i Additional work to be pe orme -uncler this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric zflumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq.Ft.of First Floor: Cost of Construction:$ �� d ° 0 C Utilities: _Sewer _Septic Building Height: Name Name: Address: 2l 7 S /�-���'�� ��N Company: P,4v/ F, City: Fox* ?>is2� State;zzl Address:. 4142- 4v,�i2i� r3/vim Zip Code: Z Fax: City: �Lt, 1�ii5/1� State: Phone No. o Zip Code: 3`/�B�Z Fax: E-Mail: Phone No '7'7 Z v/3-3 Fill in fee simple Title Holder on next page(if different E-Mail ✓ "'"•f z from the Owner listed above) State or County License (f/j2 O 3 3 $l 5� If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 recqrdigg your Notice of Commencement. Signature of Owne'/L s ee/ ontractor as Agent f nq `; Sign ture of Contractor'Lice n a Holder STATE OF FLORIDA4 �,� STATE OF FLORIDA COUNTY OF bf COUNTY OF =J12 z m;M �"�m The forgoing instr t was acknowledged befo $h -W The for oing ins rum nt was acknowledged bef this day of 20_ by s S this day of 2o 7_ by p� e (Ov rn �N< ( ame of person ac nowledgin ( ame of person acknowledg g) (Signature of Nota Public-State-of Florida U (Signature of Nota ublic-State ofFlorida) Person Known OR Produced Identification Persona nown OR Produced Identification Type of ion 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: