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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: O '- Permit Number: 5d� ' d3 RECEIVED AUG 212015 _ P 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 V PERMIT APPLICATION FOR: PROPOSED lNPROUEME T OCAl"0g: Address: �02 �-P ��( . /-e l Ce LJe 7 Legal Description: Property Tax ID#: q '7 3 a D oO t o oC7o Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: ©fTA�ILED DE�SCR�IPTION OF WOR : CONST'�UCTiQN I:N�F©RMATIQN: 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: Cost of Construction:$ oZb .d d Utilities: —Sewer —Septic Building Height: ®WNER/LE-�SSEE: CONTRAC mOR: Name /Gl�L2em/YLO Name: Add re, s: r Ie I,rL Company: City: (�.�5* •1' .k 'u State: Address: Zip Code:3 Fax: City: State: Phone No.132- 70-�?J J 5 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 Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPI @ 0 1 @ N'MAI 100 39 NSTWIENFQRMATI®.N: 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 per 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 commencing work or recording our Notice of Commencement. Signatur o'f Owner/Lessee/Agent Signature of Contractor/License Holder �':- :STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 'S-Jr. 1-,j COUNTY OF The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me this Q.'\ day of 20_ by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pu6U--State of Florida) (Signature of Notary Public-State of Florida) Personally K wgiiiiiii--, OR PUgkggqtc%lpLqRtificati . Personally Known OR Produced Identification PfiYPbji Type of Iden f ;`�; Notary Public-State of Florida Type of Identification Produced _My Comm.Expires Dec 16,2016 Produced Commission#EE 858761 Commission 0FAgQ oghNatio g',& yAssn. Commission No.. (Seal) g REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.