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HomeMy WebLinkAboutBuilding Permit Application 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 X Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential /L PERMIT APPLICATION FOR: p1 05E 3I I�RCVEWNTLOCATION: Address: Q : `� [ �a Legal Description:_ PC, w � c rwu'iz /� � / IC L" Ld Property Tax ID#: rr — Lot No. Site Plan Name: 4 Block No. Project Name: Setbacks Front Back: Right Side: Left Side: p E LEQ C IIPTIOWOF ECO::N�T��U' TflIEOMTI ` _... .. ,9. .. .. Add itionat . wor to a pe Dime un er t is permit—c ec a t at app y: _Mechanical J 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: Utilities: —Sewer —Septic Building Height: Jl11� JLSEE ._ CiTRACT©R , Name ey Name: �;�rtf' - C-r/4—�1/ Address: 3 Ci��� Company:_ 1�.1� e' L/i'Lt f42 V4%t !'✓t� City: w fi r�1'{-e-- Stat Address: Zip Code:3 (2 c12: Fax: "(/ City: Fc✓'r a State:_.. Phone No. 7 7 2�—,3 Zip Code: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail . from the Owner listed above) State or Cou y License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. t"q "'No-'M 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 commencinIg work or recording our Notice of Commencement: l Signature of Owner/Lessee/Contractor as Agent for Owner ignature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORID r COUNTY OF _ �- - ,tc�e _ = COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this G day of IBC t ` ,20 a1 by this dayof Cat i 1 ,20'a1 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State o``��A�iHblllr1p (Signature of Notary,Public-State of ft9AI0Q,///z ``�� �RF_ND,4 A fJri :1 `���� BRENO ��y Personally Known�/ OR P duceee I �ic �f� Personally Known OF`�r duc ni�i�n •'• Type of Identification r Type of Identification A4R 12°yam¢. _ ,• APR oy Produced _�� :� `oA: Tn Produced o gym' m _ � ��• rn ` Commission Now (� �` p 6( Commission No.G((79�+ ��� 98ss�§ea�) m= i�!/ `:TState iniv?�: ��� �i/� :S/aye�suczE:•' � �� llf ///l11ilIHl1! 1�\\ �!!1UF 1 R ' \ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.