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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ""1 acs` S Permit Number: - Building Permit Application Planning and Development Services Building and Code Regulation Division / 2300 Virginia Avenue,Fort Pierce FL 34982 V Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: 514 PROPOSED INPROUEMENT LOCATIO : Address: VS. I-S w 'mei u Legal Description: Property Tax ID#: a`�a`b - 01 baa6 4d4—� Lot N Site Plan NaT�e: Q� Block No. Project Na[ne�`:� Setbacks Front Baci: Right Side: Left Side: DETAILED DESCRIPTIO (W WORK: s C 7 / ray,/, / � � l � \ v Cf f V6( CONONE, CTIO-N INFORMATION: Additional work to epeffo-rmed under this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric Plumbing Sprinklers _Generator _Roof W9. Total Sq. Ft of Construc i of ` / Sq, Ft.of First Floor: Cost of Construction: $ Utilities: Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name y-xY Name: Address:'_2J-6�� t3 b _i Company: v�c`7�✓ City: Address:4G v W Zip Code: �7 �2— Fax: City: 11111hi, /� State: Phone No. ` ���� ©� Zip Code: G 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 Lte of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENT L CONST� UCTION LIEN lAW IN 'URMATlON: 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before commenc' work or_&xpr4ing your Notice of Commencement. Sign ure of Own /Le see/ en Si ature of C tract r/Lice se Ho r STATE OF FLO STATE OF ORI A , COUNTY OF ��_ L>Jc�� COUNTY OF S �� The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this3b day of �Uy 2015 by this'3�day of J J VA 20\5 by (Name of perso acknowledgin ) (Name of person cknowledgi g) (Signature of Notary Public-S to of Florida) (Signature of Notary Publi -State of Florida) GIVENS All Personally Known OR Produced Identi 'c Personally Known � uced Ider>�f % Florida - Type of Identification r GIVENS clda Type of Identifi ation a*``P°B; Notary Public 201 Produced L b L SEP NA State o1;6 2016 Produced 1— _'2.`�«mac.`_My 0omm EXPires r-E 858761 ry Pub spec Commission# pss °caom ExPtte EEa5aj6 ssn• �5 '° pec Bo Th ugh National Notary Commission No. . ll # olacy P Commission No. - C oto � h National N °rc ndedtbtou9 REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.