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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i Date: Permit Number: RECEIVED Building Permit Application Planning and-Development services SFP 13.2018 Building and Code Regulation Division , ermitting Department 2300 Virginia Avenue,Fort Pierce FL 34982 cr Uucie County Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _ PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: l d \ m r-1y e �1-ate - P x'C c_ Legal Description: ra.�;� -t �P� � �� �� I ) ���- ng, •Rx_� c's ©?-, --Fobo � �1 Property Tax ID#: ')-)LAn;), —lQ OC'k —f, k ?�' - n oo-C7 Lot No. Site Plan Name: Block No. Project Name: 600c_ Setbacks Front Back: — ht Side: Left Side: DETAILED DESCRIPTION OF WORK: q r CONSTRUCTION INFORMATION: Additional work to be performedunder this permit-check all appy: HVAC L_1 Gas Tank ❑Gas Piping _Shutters NWindows/Doors Electric 0 Plumbing Sprinklers [i Generator 1:1 Roof Roof pitch Total Sq. Ft of Construction: 1. 09LA S Ft.of First Floor: N."A Cost of Construction:$ �i O Utilities: Sewer Septic Building Height: OWN ER/LESSEE: CONTRACTOR: Name C _"f_ _ Name: y Address: P a : �r _ Company: .City: 'off 3 Stater Address: Zip Code:?, Fax: ?ty: , o 0 yg� 1 e r-c(2- State: 1�7_L !Phone No. ,� t-�-� � o Zip Code: y _=� p Fax: E-Mail r- Phone No. (P'1 'Fill in fee simple TitQ01clelgh next pag f different E-Mail: from the Owner listed above) State or Coun is q If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SOPPLEMENTAL,CONSTRUCTION LIEN LAW INFORMATION,: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ?C 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 11 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 obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. S gnature of wner/L ss a/Contractor as Agent for Owner i nature of C ntractor/ icen a Holder STA FLORIDA STATE OF FLORID COUNTY OFSAA 01inAQ_, COUNTY OF , The fWoing instrument was acknowledged before me The forgoing instrument was acknowledge before me this day of 20 l ,by this day ofSo, 20 by Nam of-person making statement Na*e of person making statement Personally Known OR Produced Identification Personally K own OR Produced Identification Type of Identification Type of Identification Produced z Produced YrL IQL (Signature of Notary Public-State f Florida) (Signature of Notary Public-State of Florida) Commission No. f—„ouu;•- L(Seal)iNA INGRAtJ Commission No. Seal P �� �1,o aFy��Sll�=§talll Ol flOri,l� �,�.� _��.- '_= 1�=�” f3 LASHAHNA INGRAM ESC Ik@ t, ;,s�. j ma.�;i n ;�� a n v Public State of Florida ' \ -s �• r', ,, Mary Assn.l '.° *•-My comm.Expir es Der'? ,L REVIEWS FR o w.� roug teir 03 VISA 1 PLANS VEGETATI 9 ��, M%�IV� OV COU n6,+t REVIEW REVIEW REVIEII''.,,,,,,,,,,`IATQbPoTriiion1 rn. For F .� RFUMMough N tion- DATE RECEIVED DATE COMPLETED Rev.8/2/17