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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLEI FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: V _ > RECEIVED Building Permit Application AUG 0 6 MIS/' Planning and Development Services I ST, wsie County, PL mitting ' 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: I �� MMA-SED INRR®VE ANT LOCATION: , Address: 7 r I �'►/"�� J . _ 'd Legal Description: Property Tax ID#: co 0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front . Back: Right Side: Left Side: DETA'I_ED Df�SCR1STI IOINS ®F WNA,,[ CON�TR±t1CTIQN 1NFOR�MA�'ION: Additional work to be performed 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: 22 Sq. Ft.of First Floor: J Cost of Construction:$ o e f Utilities: _Sewer _Septic Building Height: OWN'�ER/LEASES E: ,� CONTRACTOR: . Name / .Name: _ = ` _ __.._. - Address: C� Company: City: State: -Address: Zip Code: 3 Fax: _ =City:" -,. . State: Phone No. 7 Zip Code: Fax: E-Mail: O �16 Phone No Fill in fee simple Ti le Holder on"next pageE-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. SUPPLEMENTAL C©NST� UCTION L;�N LAW I.NFORMATtON: DESIGNER/ENGINEER: _Not Applicable MORTGAGFF C MP Not Applicable, Name: Name: Address: Address / City: State: City: State. Zip: Phone Zip: hone: FEESIMPLE 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 thepermit 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 intendV intend , obtain financing, consult with lender or an attorney before commencing work or rec din You;,Wta of Commencement. Signature of Owner/ a ee Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OF !�� . � )(�,(T , COUNTY OF The forgoing instr ent as acknowledg before me The forgoing instrument was acknowledged before me this JUL\ l day of 20 by this day of 20_ by (Name of per-'(4n acknowledging) (Name of person acknowledging) r (Signature of Notary Public-State of Florida) / (Signature of Notary Public-State of Florida ) Personally Known OR Produced Identification Y Personally Known OR Produced Identification Type of Identif' 'on Type of Identification Produced L �. ced KAREN S. NIELSEN Commission No. ?_ ;tt�iie of Florida-Notary Prifl ission No. (Seal) ;me #GG 20 484 ±.fOfi�Oa?c My Commission Exp'res June 12 'M519 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.