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HomeMy WebLinkAboutbuilding permitALL APPLICABL INFO UST 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Address: Legal Description: -6---�-91 Il I S - Property Tax ID #: -3 4 Ua " „I} oq - o G Q ­7 - 0oo 'a_ Lot No. ) Site Plan Name: Block No. ) Project Name: 'e 1-eX U I S Setbacks Front Back: Right Side: Left Side: S -7-n 14 S-et,-r 0HVAC 0 Electric 0 Plumbing Sprinklers Windows/Doors L� Roof Total Sq. Ft of Construction: - S Ft. of First Floor: 7p Cost of Construction: $ �� , Utilities: Sewer El Septic Building Height: Name n I -) 1V60U iJ Address: City:State: Zia code: 3Ciq Ss a Fax: Phone No. .��a E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) Name: Company: Address: S City: Statef�L Zip Code: I Fa)(.7-L2-Y 7R-s/ qq Phone No.--nQ - 'C�/ jj--� E-Mail: State or ounty Lice nse:C_PCQS-l9eS if value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea. DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Na rne:_ Address: City:_ 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signa ner/r/ Lesse—e/Contractor as Agent for Owner Signa ctor/Licen a Holder STATE OF FLO�IDA STATE OF FL D COUNTY OF r�-��I_QCA.L COUNTY OF 1 �Q The forgoing instrument was -acknowledged before me The forgoing instrument was acknowledged before me this day of 202! by this--23 day of A0-� / 20�d by !yam QC � C � � �� G nFi Name of person making statement. Name of person making ent. Personally Known uced 1CMERWfuatfatn+ Type of Identification �: Notary Public -State of Florida �stat Personally Known (/ © "' :uced I a Type of Identification Notary Public - State of Florida Commission # GG 916233 `'c.ti? `�''� t?:' Commission K GG 916233 Produced mm. Expires Oct 6, 2023 Produced ,,, .. m. Expires Oct 6, 2023 Bonded through National Notary Assn. Banded through National Notary Assn. (Signature of Notary Public- State of Florida) (Signature o Notary Public- State of Florida ) Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 2/7/19 BUILDING & CODE REGULATION DIVISION J _ 2300 VIRGINIA AVENUE s FORT PIERCE, FL 34982 • 772-462-1672 FAX 772-462-1148 AUTHORIZATION FORM FOR CREDIT CARD PAYMENT — CONTRACTOR LICENSING TO: St Lucie County RE: (� Permit # Credit Card Users: 1.5 Surcharge added per transaction. Payments must be received in this department by 4:00 PM for transaction to be processed that day, if not it will be processed the following business day. VISA MASTERCARD DISCOVER Credit Card Number O C1 C 1 Expiration Date Code 3y-L 3 digit security code L `7 Amount $ + 1.5% surcharge = Business Nan Authorized Si Print Name: Phone: (72� ) S 7 �" - ,5 14f 5 Fax: (`7 7 ) 3 - r= / '-� 4f Comments: SLCPDSD Revised 4/01/2013 EN