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Building Permit Application
j r L ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: I Building Permit Application huy' -1 3'2017 Planning and Development Services Building and Code Regulation Division i�MIT ING 2300 Virginia Avenue, Fort Pierce FL 34982 5t• Lucie County, FL Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential HERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line rR00Q5D„IpMPRQVI"MIfiiT t;CtCATttJ 1. ,rirlrpcc• _ J/�1�� ��� E �Y—� /!� �Y'. i i A✓'Pp �'L ��'7 Legal Description: Property Tax ID #: Site Plan Name: Project Name: _ Setbacks Front i i 8• a .!J�. •, .• �.;� "i .�, ..►.: is ` �0 . • i 1i e_�j irn e+-,> i rood' Lot No._ Block No. Additional work to be nertormed under this permit —check all apply: 11HVAC Gas Tank ❑Gas Piping In Shutters a Windows/Doors Electric Plumbing Sprinklers I Generator © Roof Roof pitch Total Sq. Ft of Construction. S Ft. of First Floor: '% Cost of Construction: $ , 660 Utilities: Sewer Septic Building Height: 'AM z_ Name i Name Name: Address: BdDs Company: City: Stater Address: Zip Code: Fax: City: State: Phone No. q 54 - at 6q Zip Code: Fax: hone No. E-Mail: a_L• E-Mail: Fill in fee simple TITee Holder on next page ( if different State or County License: from the Owner listed above) If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. Name: _ Address: City: Zip: EER: _ Not Applicable State: _ Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address: City: State: _ Zip: Phone: BONDING COMPANY: Name: _ Address: City:_ Zip: I certify that no work or installation has commenced prior to the issuance of a permit. Phone: Applicable 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 recording your Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of . 20 _by U (Name of person acknowledging) (Signature of Notary Public- State of Florida ) s Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of 20 by (Name of person acknowledging) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced I Type of Identification Produced Commission No. (Seal) I Commission No. (Seal) Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ' SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS 17)).004 DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: .k- Not Applicable Name: _ Address: City: Zip: Phone: State: FEE SIMPLE TITLE HOL ER: _ Not Applicable Name: fli4hKtl Address: Ec ` t City: i e e,—r ` a Zip: 3z�9S1 Phone: 15�-d�8-�1��9 Name: Address: City: State: Zip: Phone: BONDING COMPANY: Name: Address: City: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit. Applicable 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 comrnencing worK or recorcling vour Notice oT LOmmencement. 4 Signature of Owner/L sse Contractor as Agent for nee Signature of Contractor/License Holder STATE OF FLORIDA CC ®, STATE OF FLORIDA COUNTY OF .�f. ,u�,•� o _ COUNTY OF The forgoing instrument was acknowledged before me this lay of MoVP,-m8P—, R 20 Zby The forgoing instrument was acknowledged before me this day of , 20 by f A/V7 ib/VV FA—e")rla (Name of person acknowledging) (Name of person acknowledging) (Sign of Notary Public- State of Florida ) Personally Known OR Produced Identification Type of Identification Prod'WRii,FU L y SJ -0�1�i/ 9_y2 ► -� Commission No. * * M1'CO §@ARN?FF9=1— EXPI ES: Apra 9, 2o2o ry' anoF`O' BMW ftBudpiHobrySlnin Revised 07/15/2014 (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Type of Identification Produced Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION �� SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS