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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,p Date: Permit Number: ( bO�0 - - 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 _ F PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ,10 • . , \ Address: 9 0 ,��5 t4v2i Legal Description: Property Tax ll)#: 643- ©a 69 -4(-V 2, Lot No. _ Site Plan Name: Block No. 149 Project Name: Setbacks Front Back: Right Side: Left Side: E, 61 7Ti r)9I e 6, Lt(1CL r{fit la et- N-P-40 A Mae-1>h- n 91,�s y u�nc -r10-y rn-e-0, a rJ r P.. .._r_I �e oR q e, n bI GS Cpl .d and �Pr u� p r` Rition4alwork to be nertormed under this permit—c ec a app y: HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors — Electric! 0 Plumbing Sprinklers Generator Roof �, Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: Cost of Construction: $ 5 5 n p Utilities: Sewer Septic Building Height: Name Oo 4 V104kc<) av_ Name: Address: KNY) 15 '4 to y _ company: City: -4-�IState: �''� Address: Zip Code:54C( S ( Fax: City: State: Phone No. 77,;1, - Zip Code: Fax: , E-Mail: 1 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. 14 DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name:, Name: ' Address: Address: City: State: City: State: ' Zip: Phone Zip: Phone: `l 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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in contlict 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. I 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 y WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for i.r; 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. :i Signa a ofCt ne V1 /Contractor as Agent for Owner Signa a o 'of C ntr nse older STATE OF FLORID STATE OF FLORIDA COUNTY OF COUNTY OF_ , The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of ,20_ by this day of 20_ by Name of pe son mainokbtement Name of pers n ma tement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced L i (Signature of Notary°Paiflic=Statetiof`Fo r -7INGRA (Signature of Notary Public-State Florida) a ��"., LrPatI� fi ;'�`;a L;`�; Notary Pu +Sic- ida Commission No._ = - � LASI1AliNP IN7RA :"y Comm.`cx�S018 Commission No .o�a^s°, ar Public la Commissiony>Ny Comm.Expires DRnndFduah P! ssn.` ,9° Commission#F ,,,,,n„• WOO tiliougliNati—, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION” SSEA RTE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 ;i,. -i