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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: rte` �� 1 Permit Number: Q 0 1 SV Sam'. .: RECC Building Permit Application Planning and Development Services. AUG 17 2w Building and Code Regulation Division 2300 Virginia-Avenue,Fort-Pierce FC34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: IF VWX � Address: I -4ab 10b-T-k. S: ` ?,S>L- 5c 1 13 Legal Description: Property Tax ID#: � J�?�� — , —©�(� — Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: .. .,� .. - Addi i nal work to be pertormed under t is permit-check all t at app y: _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: § Name Name: Address: Company: ' City: State:-L Address; Zip Code: Fax: City: SL Stater Phone No.—.- Zip Code: ,s Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. WAIM DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: _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. gnature of Owner/Lessee/Contractor as.Agentfor'Owne ignature of Contractor/License.Holder STATE OF FL02IDA _ STATE OF FLORIDA.._r. COUNTY OF k. COUNTY OF r. The forgoing instrument was acknowledg d before me The forgoing instrument was acknowledged before me this `b day of 4 %lv . .20n by this AL day of 4k y .20V1 by (Name'of person acknowledging) (Name of person acknowledging) (Signature of Notary P lic-State of Florida) (Signature of Notary blit-State of Florida) Personally Known OR Produced JdwaghNS lersonally Known n OR-Produced Identi Type of Identification DEANNAMARIEG�N pe of Identificatio avPJ -DEANNAMARIEGIVENS ,a��4r Fva'�. Produced �-. �` MY COMMISSION#GG 022023 oduced L. ; -�w"�': (ylMl$SION#GG 022023 * '"= EXPIRES:December 16,20.0, a _.h" �3' to Noted PublicUnderW6 _ EXPIRES:December 16,2020•" Commission'No: i l rrlmission No dedTn J icUndervniters REVIEWS FRONT ZONING .` 7SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW _'•'REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE CGMPL'ETED Rev.