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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CON .___JED FOR APPLICATION TO BE ACCEPTED Date:-(% — /S Permit Number: r �+ f L4AU ea - + - 13WRA�� 9 i$e"'rmit 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: I PROPOSED INPR©UEMENT LOCATION: Address: f' © � Legal Description: I I Property Tax ID #: �/j 7 o���— OdO� —ODDS Lot No. Site Plan Name: I Block No. Project Name: : 10 -P�f- Setbacks Front Bad . U Rig t Si e: Left Side: DETAILED D'E�SCR+IPTION OF WOR+K: Ce-. 4 elv) r_' 42— i C®NSTRUCTION INFORMATION: Additional wor to be pertormed under this permit —check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: / Sq. Ft. of First Floor: Cost of Construction: $ 7�� r)0 UtiTFfies: _ Sewer _ Septic Building Height: i O�WN;ER/LE CO'NTRA.1s; ; Name 1 �iName: Address: yTy d 1'Cc t-7c.2 42:e (Company: (Address: City: a-e— State: City: State: Zip Code:V9 V 7 Fax: Phone No. %��/ y�S .� Zip Code: Fax: E-Mail: L'GL &$4A_,-cv' f —e—. NoFill in fee simpa Title Holder on next page (if OierenLt EMI Mail State or County License from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement �I encement is required. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name:_ Address: i Address: City: State: City: _ Zip: Phone I Zip: FEE SIMPLE TITLE HOLDER: _ NotiApplicable Name: Address: City: Zip: Phone: Phone: BONDING COMPANY: Name:_ Address: City:_ Zip: Phone: State: Not Applicable 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 thatlis 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 Fllorida 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 yourlNotice of Commencement. I I Sig ture o O ner/ ssee gent Signature of Contractor/License Holder STATE OF LORID STATE OF FLORIDA COUNTY OF ,,Q COUNTY OF " Th forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thi day o0 20f by I this day of 20_ by (Name of rson acknowl dging) I (Name of person acknowledging) (Signature of Notary Publi&AState of Florida) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. I I (Seal) I Commission No., (Seal) ' REVIEWS FRONT i ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED I DATE I . COMPLETED ev.