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HomeMy WebLinkAboutBuilding Permit Application (2) ,I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ©h,2 O/ Permit Number: : .1 Building Permit Application Planning and Development Services Building and Code Regulation Division j 2300 Virginia Avenue,Fort Pierce FL 34982 ,Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential J PERMIT APPLICATION FOR: i! I � � PROPOSED IIN RC�?VEME�NT LOCATION: Address: -e Legal Description: 17 i Property Tax ID#: 2 5/0 Lot No.� Site Plan Name: Block No.. /meg Project Name: iI Setbacks Front Back: Right Side: Left Sidi: DE AILED DE�S'CR�IPTION OF UUORIC: Zr i 12 CONSTRiJCTION j INS F-M ATION: ll[lllll OWN itiona I work to be pertormed un er this permit-check all that appy: y _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: Cost of Construction:$ ®fid .�= Utilities: —Sewer -_Septic Building Height:. .I d . OUIINER/LE�S,�E��• C®NTR/4, 4R• Name Name: / e� Address: n r' - Company: City: State:/5Z- Address: Zip Code: . Fax: City: I State: Phone No. / Zip Code: 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 1i' If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLE�MENTALCONSTeUCT'IC�?N I.ILN I�► IN�FORMAi'ION. ' DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPAII _ Not Applicable Name: Name:... Address: Address: City: State: City: State: Zip: Phone Zip: Phone:' FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _NotApplicable 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 concurren'cy 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 commer)clng wor or rjecorft your Notice of Commencement. Signature of Own erxLessee/Contractor as Agent'for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OFCOUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this Q_�j day of e CA 1204a by this day of 20_ by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identificatio Type of Identification Prod edProduced (S' n urla of Notary Public-State of Florida) (Signature of Notary Public-State of Florida ) Commission No. (Seal) Commission No. (Seal) i REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER . REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.