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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l 03- C>a01 Date: fill Permit Nu l I Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMITTYPE: Address: Property Tax ID #: Site Plan Name: _ Project Name: _ 2'5 -7 Ol MAR 12 P018 RECEIVED Permitting Depart Building Permit Ap'~iennt 4:Yfnitting Departmc' Residential Commercial MAP ' ° '� Lot No.'2�._ Block No. g CONSTRUCTION INFORMATION: Additional work to be performed under this permit— check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _Electric _Plum/!bing _Sprinklers _Generator Roof LO Ic� Pitch Total Sq. Ft of Construction: "t a 4 Sq. Ft. of First Floor: Q'1 Cost of Construction: $ ZZ©C7 . 6Utilities: _Sewer _Septic Building Height: OWNER%LESSEE:. _ •': .`_ CONTRACTOR-,,,> Name N �- ��I Name: ., A Address: r L Company: Q t p ar City: P- P I C 2 L o State: _ Zip Code: n/(-(% Fax: Phone No. rsLb7 Address: G 6 2 15 0 -0 J— A! City: C-C� State: 4 Zip Code: '::�(107�7 l ,A Fax: Phone No �- �r 1 S 1 Z E-Mail: / lay- Fill in fee simple/Title Holder on next page ( if different from the Owner listed above) E-Mail n LI_``(\ I Q. t.J 'k,- r r--,eA ,✓ State or County License N` If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. 6 • 0 SUPPLEMENTAIGONS7RUCTION LIEN LAW INFORBt�ATION ; w DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: Zip: Phone State: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: _Not Applicable 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT Signature of as Agent for Owner I Signature of Holder STATE OF FLORIDA ,�y_STATE OF FLORIDA COUNTY OF _!.I w C_U COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument wa acknowledged ��bbefore me this ay of,20 lby this (Z day of ,201�13y R ucho p(J k ra C� ,t V, Rc�him Ta�chu.E% .Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public -State of Florida Commission No. of REVIEWS IN Personally Known OR Produced Identification Type of Identification �L D / Produced f�C. C_ (Signature of Notary Public -State of Florida Commission No. PLANS REVIEW