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HomeMy WebLinkAboutBuilding Permit Application -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � 15g-� Date:'()- 1 �� Permit Number: _ 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: ggm ` A[ Oil z"x °� Address: �.�� T� ��/ 421 r, Legal Description: Property Tax ID#: JI �o� `' C5`�� GO�o Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: `.. Rfi INN �.,c_ f -�>' -L �`�&''�.-�;w¢. ,�*.'a .'��.f.'a'S�-.. -.....r,"�r kr,'�� �.�-.:st�l ,n ,` t#„�':ni� ,.�.M,.-�_.-�`�• 'as..�„_ L..'s: ":s "^� . .. .. „ p� x . itiona worktoNe performed un ert is pemit—c ec a t ,at ^*��s�t�•.j�ica.�"'4�_'.`�.�t'"...:w:��.�-a'r'::. ."�"t .: t --�3.s-r- , appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing rinklers _Generator _Roof Total Sq. Ft of Construction: l 00S Sq. Ft.of First Floor: Cost of Construction:$ Utilities: _Sewer _Septic Building Height: .•�-"- t_tee»- al +" ry��t?�ii. '.�. U f' t a: ii y +y tar �C t s €" n . r�33^i':';,'k r;1s.R� s. y Name i 2--e— Name: Address: S_ 15- Company: City: C'.��'�— F ate:_ Address: Zip Code: rJ S-/ Fax: City: State: Phone No.71 `Z ( Z26 �--2 ��/ Zip Code: Fax: E-Mail: Phone No. 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. i 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 apermit 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 commencing work or recording our Notice of Commencement. Signature.of Owner/Agent/Lefsee Signature of Contractor/License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OF COUNTY OF The f oing instr en was acknowledged,. before me The forgoing instrument was acknowledged before me this day of 20_L by this day of 20_ by RID (Na a of a son acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced `'Z�t' 1�1� (' Type of Identification Produced Commissign o. RIP DEPOSIT t fnVion No. (Seal) jpt Ap�^La OFC©UICIE V COvNTY130ARD • �� • +� Notary Po MI ON f WING y,�� Y �'St e7�j ING #X OKIYS VEGETATION SEA TURTLE MANGROVE OF OG,``. es of ; 2REVIEW FLREVIEW REVIEW REVIEW �R�i� DATE 71 RECEIVED r�oghNarional olaryAssa. DATE COMPLETED -R—ev—.7/2014