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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL . f FOR APPLICATION TO BE ACCEPTED Date: 42 / SCANNED Perm V 175� J it Number: U BY St. Lucie County _ Building Permit 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: Address: G/vcl6sn-14/e 4..a . X'sL 3 Legal Description: & Property Tax ID #: 33©9 6egx- DO Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 'Ke AoiL I'ye- .4/G nical e Gas Piping _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer _ Septic Building Height: Lo _ Gas Tank . Shutters Windows/Doors .. Name r, ok— w ` e Name: ®J' ^ 2.2 Address: S9 ,1 J 4'l . ,. City: �� ,� /-ye 52 State: 4C. Company: ,* cf hle4te,JU Address: 1 // 3 &44f ,^S' ^ Zip -Code: Fax: City: State:f—C. Phone No. 222- 212 .3 - e/a Zip Code: 34/Se ? Fax: Wd E-Mail: Phone No.%%?- 3-?-?0 Fill in fee simple Title Holder on next page (if different E-Mail: s tiG� S = ff So;:vf h• nP% State or County License: from the Owner listed above) If value of construction is 2500 or more, a RECORDED r4otice of Commencement is required. DESI NER NotApplicable G ENGINEER• . MORT N • —GAGE COMPANY: of Appllcable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone - FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: —Not Applicable Name: 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before coVimencing work or recording our Notice of Commencement. ignature of Owner/ Agent/ Lessee i nature of. Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA 6 COUNTY OF COUNTY OF The fp[going instryment was acknowledged efore me this day of 20 by The f r ping instr ent was acknowledgell Yore me this of 20 ay y (Name erson ac nowledging) (Name erson a nowledging ) (Signature of Notary Publ' State of Flo 'da) (Signature of Notary Public- a of Flori Personally Known OR Produced. Identification Personally Known _OR Produ.ced_Identifieation N Type of Identification ro �� �.� Fj _-. Type of Identification ?,r9 rvced DAWN MI'LONL , DAWN MILONE `ISPRY P1, ,, Commission No. =a°. ,`' "' Notar State.of Florida ='o`P ,; �a Notary PubTIC ra e 2 ! a i a =, ' M Comm. E r ar 22; 2017 Commission No. �1°; y m 877571 My mm. Expires Mar 22, 2017 Comm.Expires Commission # EE 877571� -.Commiss '%;° ;; ;°P�` Bonded Through National Notary Assn. -pnNs'af", Bonded i nrougna Iona REVIEWS FR Z N S PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Ev.