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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: . Permit Number: , - RIF , ` 'tet—+,. •' •wa:r , - k"r 0 -m D Building Permit Application OCT 012018 Planning and Development Services Pei i i' fitting Department Building and Code Regulation Division St. Lucie CloU Fltyo FL. 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential I PERMIT APPLICATION FOR: P OM @ D iNRROUEMENT L®CATIOiN: Address: S 0✓1 0� T— Legal Description: Property Tax ID#: o �7 5 b a �7 0'' 60 — Lot No. �9 Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETA LED DEaSCRIPTIO 0 WORK:. a nom' ,V c, e G ba,' =VNIM-1CTIfJN 1NFOR A ItJN: MW Additional work to be pertormed under this permit—check all a at appy: _Mechanical _Gas Tank _Gas Piping Shutters" Windows/Doors _ElectricPlumbing _Sprinklers Generator . _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First.Floor: Cost of Construction:.$ �l � Utilities: —Sewer —Septic Building Height: OWNER/LESSEE.: _ CONTRA.' UR: Name Ar-\ Q l LLL_ Name: L'i Address: `�L� � c.�i �c� Company: City: o{a afo ectc� State:C4- Address: Zip Code: o0, Fax: City: e— State: �L Phone No. --2 • I Zip Code: '36/'3 Fax: E-Mail: Phone No L/ 7 7 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License 4'— ocC /r9?, 8-g 6P 7 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. pill SUPPLEMENTAL C«©NSTRUCTIQN LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _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 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 intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. Signature—'of Owner/Less ontractor s Agent f r r0141neg Signature of Contractor/License Hp er �• ¢^N 9 � STATE OF FLORIDA STATE OF FLORIPA COUNTY OF CL sl COUNTY OF r - =C:) z o ,.SQ66 6 m WSJ The forgoing instrument was acknowledged for ty The forgoing instrum nt was acknowledge?e r-gu " this day of� f 20 d by c3 RX 9 this 1 day of - 20/ a�w g W m fl,kne 0Woe� (Name of person acknowledging) . cknowled ing(Name of erson a �21 (Signature IV otary Pub ic-State of FWbricla ) (Signature of NCON Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.