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HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Dater d / Permit Number: r/ e?- aIs­-0-34 IM-10-1 �b s RECEIVE Building Permit Applicatio MAY 10 2D18 Planning and Development Services Building and Code Regulation Division Permitting De pa rtm nt 2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentla PERMIT APPLICATION FOR: 1?-76� }?6r-r2 CA.,—�' PR+OWIN I@ INRROVEME/NiM I L©CATIaN: Address: /YGvI. ✓ • J ^ T-1l '3 Legal Description: Property Tax ID#: Z-- Co o 4) 3 7` 06-02 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: ':! Left Side: DETAILED DESCRIPTION Of WORK: / S CJ 5 w=� to %iAdd CO STR�UCTION INFORMATION: itiona I work to be pertormed under this permit-check all that appy: mechanical _Gas Tank _Gas Piping _Shutters ---Windows/Doors. Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: / Sq. Ft. of First Floor: 6' Cost of Construction: $ ' Utilities: —Sewer _Septic Building Height: OWNERjCONTRACT®R: Name ! !r'�i2 / Name: Y"lS Address: 7 COC 1 '2 'i C�k Company: r City: J - ! -e f State: Address: c (� 1� Zip Code: City: m& - State:. Phone No. `7'7 2 - b g5-�z Zip Code: Fax: E-Mail: Phone No 'a'a - D 'Z-!7 (�7 Fill in fee simple Title Holder on next page(if different E-Mail ✓i ," < from the Owner.listed above) . State or County License f O If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ��,� Sl1�PPLEMENT'AL C©NSR.t�Cl"ION L11EN LAW I'N-F®RMATI®N: 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 o cing, consult with lender or an attorney before commencing work or recording our Notice RV ncement. A CtAAA- Signature of Owner/Lessee/Contractor as Agent for W�,v Signature of Contractor/License Holder g �` s Xn D ?7 y c P 2 � l STATE OF FLOR' m STATE OF FLORIDA �/ 0v COUNTY OF N�W COUNTY OF �° o inc The forgoing instrument was acknowledged before m =°'T,��, The forgoing instrument was acknowledged bef rk this day of 2y0� `by ��� this, y day of 20L� b m (Name of person acknowledging.) (Name of person acknowledging) (Signature of Nott y Public-State of Florida Y (Signature of Noo6ry Pu lic-State of Florida ) Personally Known/ OR Produced Identification Personally Know�er� OR Produced Identification Type of IdentificationType of IdentifiEation Produced Produced Commission (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.