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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: "T ��` Permit Number: RECEIVE Planning and Development Services Building Permit Application APR -9 201$ Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 arm itti n e pa rtme t Phone:(772)462-1553 Fax:(772)462-1578 Commercial Resi enfAl le County,, F PERMIT APPLICATION FOR: To Select.from dropbox, click arrow at the end of line PROPOSE_D IMPROVEMENT LOCATION: ' Address: ], I�`� 61J i4A 0 1A A V Legal Description: g P Property Tax ID#: .39 101 S15 00,P 6 DU© y Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF-WORK: CONSTRUCTION INFORMATION: Addition workto e e Orme under tispermit-c ec a appy: VAC Ei Gas Tank Gas Piping _Shutters Q Windows/Doors 0_Electric 0 Plumbing U Sprinklers Generator Roof Roof pitch Total Sq.Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ `�1 UU Utilities: _Sewer E]Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name IN 1 S W K I Name: "Rl e-14APA 14,L-I;,A 14,,- Address: 1 1 9:� N L C-,0 i eCA-66 AU Company: co t..-4 Ize MLe. INC City: ?v 2s Ss Lu L L !_ State:- -� Address: a 3 3 N<�_ j�v,R-I Z�n� LA� Zip Code: 3t4 a►,i X Fax: f City: ?L,fl-1- 57 to C-tL Stater Phone No. �- PIT)E, Psi C1 Zip Code: 3HFax: E-Mail: / Phone No. n r7 pin Fill in fee simple Title Holder on next page(if different E-Mail: 1/UC ie,4)9,Zy(3 La C IL, Crzm from the Owner listed above) ' State or County License: (-A Cv i A If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property.A Notice of Commencement must be recorded and posted on the jo �'•.,,, before the first inspection. If you intend to obt ' g, consult with lender or an attorney befor com,wwncing worKor.recording your Notice of n meo : N "•9„:a• n u•' Signature of Owner/Lessee/Contractor s Agent for i$e��� ignat of Contra ctor/UcW�se Holder a � 'G�C � �9cVC, I"tr 2-NA9 � STATE OF FLORIDA a m STATE OF FLORIDA d g COUNTY OF 1� COUNTY OF T = a Ny The fo going instrunlent was acknowledged before m �T The for oing instr nt was acknowledged before 8N this day of 20JXby 2.61— this Today of 20JZ- by a Name of person g statement Name of person making statement Personally Known OR Produced Identification Personally Known AOR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Not Public-State of Florida U (Signature of o ry Public-State of Flori a) 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 Rev.8/2/17