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HomeMy WebLinkAboutBuilding Permit Application All-APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ALCCEPTED rn Q Date: Permit Number: (gig Building (gIq lJ - --- 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 Z,-- PERMIT /PERMIT APPLICATION FOR: C17aMWWW siED (MPRa 5 E1T. cA ton "'i k � a L ash F& _ � g1FW_05 Address: j =3c Legal Description: Property Tax ID#: 3(69 so . ©lul- OW 1 Lot No. Site Plan Name: Block No. Project Name: Setbacks, Front Back: Right Side: r Left Side: _'51L �;M - w --JR 111PT!ffi` W tie say _ � �•,�. M, 9zcz A itio wor to a pe orme un er t is permit-cneCK all tat appy: Mechanical _Gas Tank _Gas Piping I Shutters Windows/Doors — Electric _Plumbing _Sprinklers Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of irst Floor: Cost of Construction:$ Q " Utilities: —Sewer —Septic Building Height: �R . .�� CQ`iiTRAa h� K Name Name: r Address: Compan o-s helj aL y ) City: State: Address Zip Code: 7441—Fax: City: — ' GC tate: �— Phone No. '7 -- �' � ��, Zip Co Fax: E-Mail: Phone N 0 Fill in fee simple Title Holder on next page(if different E-mail from the Owner listed above) State or ounty License CX If value of construction is-2500 or.more,a RECORDED Notice of Commence ent is required. DESIGNER/ENGINEER: _Not Applicable MORT�AGE COMPANY: _Not Applicable Name: Name: . Address: Address City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDI MG COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to ob ain 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 authrize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,byl ws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review y ur deed for any restrictions which may apply. In consideration of the granting of this requested permit,I do hereby agree hat I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St.L cie 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 an J 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, co risult with lender or an attorney before commencing work or recording our Notice of Commencemen ' I Signature of Owner/Lessee Contractor as Agent for Owner Signatu'e of Contractor/License Holder STATE OF FLORIDA STATEJOF FLORIDA , COUNTY OF COUN OF The forgoing instrument was acknowledged before me Theor oing instru ent was acknowledged before me this day of 201by this day of 20 by (Name of person acknowleYging) (Name o f person acknowledging) I 4( atul'e otary Public-State of FI rida) (Signa re o Notary Public-State o lorida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type ot1Identification Produced Produced ` ,1111,,,,, C I' r _t�_�. )r YAVe,, LA1�S4'2i)11NGRAM Commission No. ,� 5 al =-Co mi sion No. LASHAHNA INGRAM 11: ; - Notary P ollc-State of Florida °tPa�roa a°;My Comm.Ex ;a4 ¢� Notary Public-State of FI rida y x 4, n pies Dec 20,2018 ro c i i I ui. =xNueS eC L Cu I '.,FOF �o:` "'"��+�I m rr /Z99 N^O O' `` 'IIIIII 11` C rn u rc i 7�4g f Bonded l,aloalah N REVIEWS FRONT S'''UPERVISOR PLAN VEGETA, BNS-'=SEATURTLE :- MANGRQV: ,1111 Bond d l0iHilo 1�eannnal o a y p� �• COUNTER _REVIEW_ ;R (lE REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED - Rev.