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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: !V121 -ill z /S— Permit Number: IZALW - - - - -- 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: PRC�,PQSED ISN •RQVEM!EN�'fI].QGATIQN: Address:_14h4& Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D AILED DESCRI`PT1ON NF WORK: C©NSTI=IS"N INFOR+MAl"ION: Additional work to be pertormed under this permit-Check all that appy: Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors -Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Bd �c Cost of Construction:$ Utilities: _Sewer _Septic Building Height: 01111!INC IM, /LE1SSEE: QNTRACT©R: r t •Name ' �.� - :•1,. fN.a;me:r- i c5. ��d�J Address: ;Company l y:` '�/" state :Address:. ` -�fGj Zip Code: Fax: :City: State: Phone No. rZip Code: Fax: Sf 3-7G3-,110f1 E-Mail: Phone No 0-_ZG 3 -340 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIJPPLEMEN Ai.COnWIT, J"Cl-I0N LIEN LAUV tN°FORMATION: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable 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 t first inspection. If you intend to obtain financing, consult with lender or an attorney before commoilcing work or recording our Notice of Commencemen Signature of Owner/Lessee/Agent §ignature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this�day of 20_1,K by this day of 2015 by (Name of person acknowledging) (Name of person acknowledging) G-4�igiiature of Notary Pub' -State of Florida ) ignature of Notary Public- of Florida) Personally Known OR Produced Identification Personally KnownQrc ,ced Ide tif' a 'on Type of Identification Type of Identification ool"""" LASHAHNA INGRAM Produced r uced :r. Notary Public-State of Florida Q.(oJ�" 13 LASHAHNA INGRAM * My Comm.Expires Dec 20,20111. :r. Commission No. =��Pav �'�.;( Ry Public-State of Flo icra mission No. '�,9f. a�:' g6�ei�sion#FF 177249 • My Comm.Expires Dec 20, 018 Bonded through National Natary Assn commission#FF 17724 Bondeq through National kilar Assn. REVIEWS FRONTNS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.