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HomeMy WebLinkAboutBuilding permit appAll 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 PERMIT APPLICATION FOR: Address: Legal Description: LIct C� Property Tax ID #: I n— Lot No.— Site Plan Name: �' ! �� Block No.. Project Name: `"c tm o n Setbacks Front Back: Right Side: Left Side: Additional work to be pertormed under this permit — check an that apply: _Mechanical , Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ ',;;, 4 0" 0 Sq. Ft. of First Floor: _ Utilities: —Sewer —Septic Building Height: .'^IS6 x.'tiv.'u ,. 3 m•G.E'y .i ... _ . _ _ _S .'%. %S:s, `a "f7C .."I.'xk+, Name ` Name: Company: I Addre J, i - s City: r '�_- L (� :"�j Stateti- Address: 1l ' - City: �� E Stat 1 Zip Code:-- Fax: Phone No. �7 - i Cn�� '� Zip Code: (— Fax: Phone No _`1'-1 A L4'(n� E-Mail: E-Mail 1 (� A, I°' I Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County Licenses 4- (', ( If value of construction is 2500 or more, a RECURUEU Notice of commencement is requirea. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: State: City: 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 anyt o s wh►cn ay applyhibit such lome any structure. Please consult Owners Association andreviewyour deed for restrithat 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." Zrier s V Signature of Owner/ Lessee/Contractor as Agent f r Signature of Contractor/License older STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instr, ent was acknowledged before me day / � � 203�, by The f rgoing instrument was a knowledged before me thi �� day of )h �,_ by this3� of _ . _ Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known{! OR Produced Identification Type of Identification Type of Identification Produced Produced <OAQ _VA VI Va4 (Signature of ary Publi State of Florida (Signature of Not u lic- St t of Florida ) Comm S' KARLEYMARIEGIESYNARNEY eaI) _ ` f Florida KARLEYMARIEGIESYNARNEY (Seal) C� ©' —Nohry Pnbiic - S<:R o ��rida • CommissionliGG099801 '. • •_ Commission#GG099801 rComm. Expires May 1, 2021 r; oFF ,. Bondedth.0%aB aIWaryAssn. SUPERVISOR PL f`••' IondedthrouONO Notary Assn. LE MANGROVE REVI COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 2/7/19