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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll AP i LICABLE INFO MUST BE'CUMPLETED FOR APPLICATION TO BE ACC � ED I Datell , Permit Number: i 3 .� - Building Permit Application 1' a$-d y d� Plann"ng and Development Services euildill g and Code Regulation Division 2300 irginia Avenue, Fort Pierce FL 34982 Phon,' : (772) 462-1553 Fax: (772) 462=1578 Commercial Residential IT APPLICATION FOR: If'ir count, tt�� z . r • • nrve + - Et / W Prope 'yTax ID #: 32- -2 Lot No. _ Site Pla Name: Block No. Project .Name: Setback"" s Front Back: Right Side: Left Side: Aaaitionai worK to oe perrormea unaer tnis permit — cnecK all that apply: M I'�chanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors it El �ctric _ Plumbing _ Sprinklers _ Generator — Roof Pitch Total Sq. IFt of Construction: 3 Sq. Ft. of First Floor: 1 3 -2� Cost of onstruction: $ gob Utilities: _ S� _ Septic Building Height: �W �1 E=R%LF�S�SEE: �®N`CRACTOR; Name Addres City: Zip Co Phone E-Mail: Fill in fete from thIII Name: L� �: 3L2- ESSa Dn'yt Company: (14V cwtpn ece ire f State: Ir i : Fax: %Z� ?�/(� - J Z Z7 Address: DY,ee.LLI 124 City: Pi' e re e State: Zip Code: 3 tjgl/ Fax: Phone No_'2% 2 r 2©/ 2 Y S'D i i simple Title Holder on next page ( if different Owner listed above) E-Mail State or County License �G' / If value ofonstruction is 2500 or more, a RECORDED Notice of Commencement is required. MEN DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: _ Address: Address: . ,., City.State: = aty . State: Zip: Phone Zip: Phone: FEESIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: —Not Applicable Name: Name: Address: Address: 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 Yules, 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 �i- commencing work or recording our Notice of Commencement. Signature.of wner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDpp. �,.�/ COUNTY OF COUNTY OF "e- �4I The forgoing instrurpent was acknowledged before me The forg ing instrument was acknowledged before me this day of 20ffby this day of klLj f — 20-Lg by �— (Name_of-perso,o5 c owled (Na a of person ackno gin (Si of Nota -Gblic- St a of Florid (Si lic Nota - ate of Flor' Personally Known ✓ OR Produced Identification Personally Known PkBbkc6I9�a n Type of Identification Type of Identificati MY COMMISSION # FF902878 Produced Pu LAERVIN Produced EXPIRES:S temb�25,2019 MY COMMISSION # FF902878 Commission No.�y ExFmEs:t aea 25,2019 Commission No. (Seal) REVIEWS FRONT ZONING' SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE SR. RECEIVED DATE COMPLETED ev. 7/2014 lil