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HomeMy WebLinkAboutBuilding Permit Application .PPUCABLE INFO MIDST BE COMPLETED FOR APPLICAMONTO BE ACCEPTED Date: fir Permit Number: f -1-,,6,. RECEIVED Building Permit Appliicatio#N 2 9 2015 Planning and Qetrelopment Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pleme FL 3490- Phone:(772)462-•1553 Fax:(772)462-1578 Commercial� Residential PERMIT APPLICATION FOR: Address: Legal Description: Property Tax 10#: add-6d/ d4d 3 1 - Lot No.� Site Pian Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: "tina1worktobepertornme un er this permit-c ec 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: Cost of Construction:$ 5 S�7�Q� Utilities: Sewer _,Septic Building Height, Name_ 4'mle%46� , Ae41ey Name: 0-AkrtIS .Sa,.4nn on S Address:_ oz9 n Company: C !gT&.tt - A Cr St4 s jg ins 1A1 c el City: State: OfZ- Address: (4I5 S `fir IL2 4,&Q lin Dr - _ Zip Code_ f _ Fax:. City: d rt Iuc�� Sate• L Phone No. 5'�� Zip Code: M_ Fax: '77,a 335' 1 E-Mail: Phone No. 77.E 323 Z Fill in fee simple Title Holder on next page(if different E-Mail: _ __ mus�glr �t� Qo 1•r.� ____ from the Owner listed above) State or County License: C.•A C 0Q R J2 - SQ4& " If value of construction is2SWor more,a RECORDED Notice of Commencement Is required. � all 4 ' DESIGNER/ENCINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address- City: ddress-City: State: City: State: Zip: Phone: Zip. Phone: FEE SIMPL*F TITLE HOLDER: Not Applicable Bd>1`DING 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 Count 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 Nome 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 Buildipg Codes and St.Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:roam 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 commencing work or recording our Notice of Commencement. Signature of Owner/Agent/Lessee Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 's 7 L'V e 1 e COUNTY 01 :. a17 LV C< The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of i7yAr t 20IS by this. day of 2Q IS by Purf15' �yp'rnme' lc� _ icf{7is ,�mrnr, S_ (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of rids) Personally Known OR Produced identification Personally Known '� OR Produced Identification Type of Identification Produced r PutType of Identification Produced 8 s�ldyccoialsslot�l ' '�! Commission N©. X31) gXPIAE$:Apd#EE M¢,zol� Commission No. �"aPS�d� ++zr �d EXPIRES:April4,PA! Mdq REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER RE'VIE'W REND REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETEb Sv.