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HomeMy WebLinkAboutBuilding Permit Application (2) , All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i Date: Permit Number: ,� ! �O r 113n1 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: PRQPOSED INPRW MEN LOCATIQN: Address: "7©Z, tY' Legal Description: '}U F'C�r^ 1J w 60e- J�1�S PropertyTax ID#: 9` 03 "33.1 DODZ-ppD- 7i Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DEaSCR�1PTl©N C+3F WORK: .I C©NSTR(JCTItJN INFORMATION: Additional wor to be pertormed under-this permit-check all that appy: u Mechanical _Gas Tank _Gas Piping _Shutters ;' Windows/Doors _Electric _Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction: 2 Sq. Ft.of First Floor: 1 Cost of Construction: $ �, eyDt 0 C) Utilities: —Sewer —Septic Building Height: O+ N1ERtLE�SSEE: p�® CONTRACI"OR: Name Name: A L 17,ei't/1 c//V 0 P Address: Aot ,�/a7 on, �'!��' Company: City: State: L Address: ��? �''/�'� 5 �=���ro� Cev Zip Code: (4 q, �a Fax: City: d'SL State: .IA Phone No. = Zip Code: 3 4 `)f Fax: E-Mail: C— i4 If- L: 4l1aLoPhone No �`?� Fill in fee simple Title Holder on next page-(if different E-Mail C'©6vf)d ee_Si" ! y 4 ko I' from the Owner listed above) State or County License <, If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 'i SUPPLEMENTAL CONSTRk1CT1ON L E'N LAIN INFORMATIaN: 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. AQ-111,Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instru ent was acknowledged before me Theforgoing instrument was acknowledg before me this lb day of 20A by this ��o day of 20_ by 0 1 Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Pro uced Identification Type of Identification Type of Identification Produced Produced at re of Notary Pu Florida) ( ' na re of Notary Public-State of Florida) LASHAHNA INGRAM ot i°. � s N «<Public-State of Florida Commission No. +.=My Cmml)Expires es Dec 20,2018 Commission No. (Seal) Commission #FF 177299 _ '•, °FFA.•� _ �._ NdNu I Id I vmaryASS n' LASHAHNA IN RAM REVIEWS FRONT ZONING SUPERVISO PLANS VE TABS, PF&yTI JRTL-EStatc olVIANG VE • COUNTER REVIEW REVIEW REVIEW My gbrWrhElll/pires Di c 2QZ `UI DATE --•, ac - omm ss v F RECEIVED 'a°i� Bonded through National Notary Assn.` DATE COMPLETED ev.