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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: :sJ1 � cElvED Building Permit Application Planning and Development Services Building and Code Regulation Division i_ocir- county, Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Qua PROPOSED IMPROVEMENT LOCATION: Address: '2 .\ '�c'i �! '�—o C:�_ '� e t C� \ ��� Legal Description: 2::) Q_Y,c__ � �,-�r �q 0 1�k_ Ck c2 9-,12-n!2-- 1 ky'] Property Tax ID#: na E 9 - C°ry-) - (b. Lot No. i Site Plan Name: - o Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: C-0ory--� CONSTRUCTION INFORMATION: Additional work to be nertormed under tispermit-check all appy: HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors Electric 0 PlumbingSprinklers FIGenerator Roof Roof pitch Total Sq. Ft of Construction: LA 1 S . Ft.of First Floor: f � ` \-A.Cost of Construction:$ a o Utilities:In Sewer©Septic Building Height: _ OWNERAESSEE: CONTRACTOR: Name Name: Address: �( r; �G Compan ` _ • City: ���-� '(� e c-C C- State: Address: vt-\- Zip Code: �' \q ` Fax: ity: k: ':1 ccs state:�� Phone No. ('-L)\ 0���S_ �{�\ \�\ Zip Code:'�%{9. j p Fax: E-Mail: VCam Phone ��p o( Fill in fee sim e fide Ider on next page(if different E-Mail: % Lo tv from the Owner listed above) State or Cou ice 4: 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: C Not Applicable Name: Name: Address: v Address: City: P; State: L City: State: Zip J 4c, .V 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 Rroperty. A Notice of Commencement must be recorded and posted on the jobsite before the first inspect . If you intend to obtain financing, consult with lenr or an attorney before commencingwork or r c rdin our Notice of Commencement. SignatuJofOwer/Le see/ ontractor as Agent for Owner Signature of Co tracto /Lice se Holder ST TERIDA STA LOCO COUNTY OF V',)c e The forgoing instru ent was acknowledge before me The forgoing instrument was acknowledgeq before me this \\ day of 4 20AS by this XV day of S e p" 20 by �c S p S �n•e,�1 ��� �-@.SOS d�Q�,�v�c� Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced 'F-V Produced � (k (Signature of Notary Public-State of Florida (Signature of Nota IEcn�E n� i � gRIE115 r"vu' GG 022U2� i ���— M 1E (3OB��U2'� •fit. :�:•-m00% My COMMISSION# tag 2020 Commission No. s pEA � N 162p2`d 1 Commission No. FSe= EXPIRES: �1q' u };K IPJ N� L[111G nde.\4flle�GOM Mast tc+rs -N: o_ m o K �;r:•=i%c••., MY ;Ds�e Urd6hVP � r •o?= BondedTh __°•• EXPIRES ,aNP�bdc .,Eos;;., •�- dThN�o• ,�'igTE OF��• REVIEWS FIR T"" ING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COU R REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17