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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION11 N All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I i %1 1 q Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax- (772)462-1579 PERMIT TYPE: PROPOSEDIMI Address: I10 (p Property Tax ID #: _ Site Plan Name: Project Name: _ C/ �� RECEIVED P10-o NOV 04 2019 Wading P,�2Q� A�pplicati n A}ur103 810r1� -16 ST. Lucie County, Permitting AS 09NNVOR Commercial Residential l8' x as, sSQ h- ex.l �n - . n -i 11, Permit Number: 101 1 �.- 0 © L4 9 Lot No. Block No. Additional work to be performed under this permit - check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters . _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _.Roof ;Pitch Total Sq. Ft of Construction: g0 Cost of Construction: $ Ca- ' Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNS LESSEE: GONTRACOR Name ra Name: ( ( �Y'c � (�Pl � - ,_...=Company:.. Address: l0 . - =- -- " City: �Y p;Pc�e State:[ Zip Code: Fax: Phone No. 77 a - D't D- I T-53 Address: City: - ; i : !( State:_ -2ip,4ode; --:eFax: Phone No E-Mail: MorY) �h.-r V (10(o CL4 HAv A,'[ Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State or County License 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. S PPLEMENTA" [ONSTRV1-K10N 11111EN tAW INF0RMA710N: 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. Inconsideration of the granting of this requested permit, I do hereby -agree that I will, in all'cespecLs, perform th_e 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." Signatu a of Owner/ Lessee/Contractor'as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA 11 STATE OF FLORIDA ..� COUNTY OF L 4J il'E, COUNTY OF The f going instr nt was acknowledge{] before me The forgoing instrument was acknowledged before me this day of NM 20a by Any-blarNi Aorg this day of 20_ by -Name of person making statement. Name of person making statement. / Personally Known OR Produced Identification / Personally Known OR Produced Identification Type of Identific io Type of Identification - Produced Produced (Signature of Notary Publi nature of Notary Public -State of Florida ) ;p KAREN S. NIELSE Commission No. e'er; Sw�q� Florida -Notary Pu _ CdidHiission # GG 2074 li 7 mission No. (Seal) My Commission Expire mSW`O June 12 2022 ZONING SUPERVISOR REVIEWS FRONT PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. Z///19