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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED Date: Permit Number: QODy- 0013 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 _z�' PERMIT APPLICATION FOR: ROPOSED IN!PROUEM�ENT LOCATtt3N. Address: - �✓ cS Legal Description: Property Tax ID#: z�e /, /a �ODO� Lot No. Site Plan Name: Block No. Project Name: .Si tbacks Front Back: Right Side: Left Side: D TfA:Io DE-ASCRIPTION ©F ARK: CONST'rUCTI N I I INS FORMATIO Additional wor to be pertormed under this permit—check all that apply: _Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors Y_�Iectric —Plumbing —Sprinklers _Generator —Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ Utilities: —Sewer —Septic Building Height:. OWNER AI S- EE: CONTRA OR: Name (l f�(lWi/✓i✓lk Address: 4 gD J�fd�� �Qt�/' �� Company City:4 State: Address: t Zip Code: 3C�,� ( Fax: City: _. ._ ., - State: Phone No.2 -7,1— 7dg—"d7 Zip Code: Fax: E-Mail: /` z��y aiRl"W&a 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. aUPPLEMENTAL C©NSTRUC�TION LI��N LAW INFORMATIQ::N`: 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 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 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 recordin your Notice of Commencement. Si ure o Ow r/L see/Contractor as Agent for Owner Signature-of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �`�" COUNTY OF The Wgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thi day of 20,Xj)by this day of 20_ by LAWA R�_i Srn 6j. Name of person Waking statement. Name of person making statement. Personally Known OR Produced Identificationy Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (Signat re of Notary Public-S e of Florida) (Signature of Notary Public-State of Florida) Commission No. LASHAHNAIN(GIW NG Commission No. (Seal) ': MY COMMISSION#GG 275NO ^' rat EXPIRES:December20 2022 Do ded Uru Notary PubG Underwriters REVIEWS �1� 1 OR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.8/2/17