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HomeMy WebLinkAboutBuilding Permit Application i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� Date: Permit Number: 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 V PERMIT TYPE: P OPOSED IMPR©VE�MENT LUCATlON: Address: - � '� �C�Y\ �( l Q e G 't- C, Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: DETAILS© DEMSC«RIPTION Of WORK: i� CONSTRUCTION INFOR+MATI'ON: Additional work to be performed under this permit—check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ �N( 10 D0 Utilities: —Sewer _Septic Building Height: ©WNERf LESSEE: CONTRACTOR: Name Name: Address: e3-5 oc' Com:pariy: City: State:U Zip Coder 0( Fax: City: =:�- " :_.._-.r,:. ra,r�i... ,,;;_ State: Phone Now l _ ���� r�[4�) + Ztp Code: E-Mail: Iyel�bd �dI�CL� l'�$�`���y► ��1N.�" Phone No Fill in fee simple Title Holder on next page(if different E-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. If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: ' Not Applicable _MORTGAGE COMPANY: _Not Applicable Name: Addre Name: ss: Address: City: " State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER:; _Not Applicable BONDING COMPANY: Not Applicable j 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 witYour 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 1 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, l accessory structure wimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use "WARNING TO W ER: YO FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FO I ROVE TS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED N HE JO TE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH Y EN ER AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Owner/Less e Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDAI STATE OF FLORIDA COUNTY �aCOUNTY OF OF The forgoing instrument was acknowledged before me his forgoing instrument was acknowledged before me this day of 20 b day of 20 by — y I�n Name of p Name of person erson ma0ng statement. makin g statement. ' ` . Personae Personally Known i OR Produced Identification y Y Known Type of Identification Type Identification Pion d dProduced Identification_ Produced {Suture of Nota( to of Notary P _ rY Public-State of Commission No. .' "�"``` ~U1SHAyNANGRAIyRAHMING` �iCorrss�onN ' Florida) mi 0. , ;.: MYC ON#G0ZISi? tV REVIEWS FRONT` YPab1*Utler� �COUN7ER Zohl G DA7-E RECEIVED REVIEW SUPER SOR REV PA DATE IOW COMPLErED R