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HomeMy WebLinkAboutapplicationAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number:c-tJm— ©L h V 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 _ X Residential PERMITTYPE: f KENOU.4T7o%I/ C ('-t/(Nl=2Gl,¢L in��b PROPOSED IMPROVEMENT LOCATION: I I Property Tax ID Site Plan Name: Project Name: 0 i 1if I/ La I (a, Lot No._ Block No. CONSTRUCTION INFORMATION: f, .11 1 1 Additional work to be performed under this permit —check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator RoofPitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: 10.0 0 Cost of Construction: $ OC • Utilities: —Sewer _Septic Building Height: a S OWNER/LESSEE: CONTRACTOR: Name Name Address: Company: 0-o on City State: Zip Co e: Fax: Phone No. —1 �7 T � Address: City: Zip Code: (Z' Phone No Stater Fax: E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail )VOSI, 100LO)ri�) • C(/}�Tn State or County License 5c •• --•.._ u• ..�•.�� uuouo u.7vuu or more, a RECunutu nonce of commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. INEER: _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable I BONDING COMPANY: '_Not Applicable Name: Address: City: Zip: Phone: Address: City: 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. i 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 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." tly-o-� i 2� G -,6� Signature of wn�Rerr/pLessee/ ont as Agent for Owner Sign ure of Contractor/License/ HolderSTA /actt/or OF STATE OF FL � � (/lJ COUTE NTYOF( L/�,L�/ll, COUNTYOFO cAl wa The oing instr s acknowled Ad before me s The forgoing instr . acknowled�3fore me this day of 2mby this_ day of 2"y Name of person makin statement. Personally Known maOR Produced Identification Name of person makin statement. Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced i Signature o Notary Public -State of on a - ture of Not ublic-State of on a KATHERINE HAVE Commission N �h ?' MYCOMMIBSION#G dS fission N�C�1 � � pt4YP4g4 KATHE MiAV€ I f NCOMMS:G .yaa�j� EXPIRES: DEC 04,2 921 pR EXPIRES: DECOEC 04, Bonded through lstStatel � Bonded through lstStM REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.