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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: DOS- 0 0C 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 0 PROPOSED IMPROVEMENT LOCATION: Address: A/ O 8 AdAt&±ta10; eeee F 3 C/ 7 Legal Description: �� .� q' AOr �Z Ot �p'f 2 Z t0 ck 2 ro b r _Z6 1 r4A.- 4.0- Ale ei Property Tax ID#: c�+ 3y �o �'�b�o 'd�1 rc CS G " �] Lot,No. Site Plan Name: Block No. Project Name: ��b��•nAr�e/v� Setbacks Front' .f4 f. Back: Right Side: Left Side:. ' DETAILED DESCRIPTION OF WORK: �,.►s ( �o��, �, -� :r� C ,,�.r u 9( o* (, q(^ it, (ovatr .�p r S 1.r i`� � . A 1( Ca..C_4,L, w' << b t yaoo CONSTRUCTION INFORMATION: Acid itiona I work to be pertormed under-this permit-check all that apply: _HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch Total Sq.Ft of Construction: •I Sq. Ft.of First Floor:' �O t Cost of Construction:$ :2 7&©. 45) a Utilities: —Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: Address: Company: v City: State:_ AdOre'ss,:•,�:VW LI S' Zip,Code: Fax: Cityru:• `g=L� � - State:a Phone No. ;? Zip Code:- Fax: E-Mail: Phone No 7Z 7214 •Fill in fee-simple Title Holdet or_i n_e_xt page(if different E-Mail: c7 C • ✓�e.I C�"!yy ar to U S from the Owner listed above) State or-.County,License: . L� If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION 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: Ad d ress: Address: City: City: Zip: Phone: Zip- Phone: 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 authorise the,permif`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 inspecti ..If you intend to obtain financing,consult w' len or an attorney before. commencing rk or a ording your Notice of Commencement. 7. SiVNT f ner/Lessee/Contractor as Agent for Owner Signa .e o o cfor/License Holde'r S FLORIDA ATE OF FLOR_IDA COF .L..u-.s _ OUNTY OF Ste'- a The for Ding instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of ) fL r h 20 f aby this day of t 20 )by (Name qVperson acknowledging) (Name o person acknowledging) ature of Notary Public-Sta of Florida) (Signa of Notary Public-State o orida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No: Commission No. LASHAHNA.INGR1►M,, . State of Flonda , �PaY 8�, LASHAHNA INGRAM Tres Dec a c oFlorida Revised 07/1 ;• My Comm•Exp FF 177249 . wr i•=My Comm.Expires Dec 20,201, <c commission#, Diary Assn. Commission #FF 177249 ' o�: 'ss, °� ationalN �''a;of R.." •�N,,, 0 ary ss REVIEWS ' -''ZONING _ SUPERVISOR. PLANS EGETATION SEA TURTLE MA Zk0VE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS -