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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ! j Date: Permit Number: / I V Ili RECLZI V il-E-7-- _- - I Building Permit Application Planning and Development Services NOV 18 2015 Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X PERMIT APPLICATION FOR: PR©POSED I PR�UEMEN1 LWCATI.ON: Address Legal Description: ,, n�;4� !gnev J"`� ��2�/ �✓/IC�� ` Property Tax ID#: , ate � �V Lot No.� Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DEQ CRIPTION OF WORK: NMI / 17 ` 6, e'0-71 <Y-e- % �- C® STDUCTIO 111, NFORMP,TION: itiona wor to be performed 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: $ Utilities: —Sewer _Septic Building Height: OUVNER/LEaSSEE: C®'NTACT®R: Name �`�17 Name: —� Address:IS(vfPalr✓r Company: oer,–Y �CvY- City: �Z ��i State. Address: Yid Z1 Zip Code:- Fax: City: State: Phone No. 31CL5_1Zip Code: '>Y A, Fax: E-Mail: Phone No �—��7� Fill in fee simple Title Holder on next page(if different E-Mail �i�2�Is•�`il> � /yJ/'1 L.c.9 from the Owner listed above) State or County License t 13 2 2 S If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLE�I1/iENTAL CONSTRUCTION LEN LAW NO 1i 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 commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Agent ;Y :'* o•: Signature of Contractor/License HolderT ._ A.� M STATE OF FLORID ' ;;; " STATE OF FLORID o eo�K;zl COUNTY OF COUNTY OF a T� The fo ing instrument was acknowledged be ge�o The f r oing instr ment as acknowledged befo this day of A-�l - 20j-b K My this day of 20 �y o "yam � mss= (-7, — (Name o person acknowledging) Wo (Name of person acknowledging) N N i^p N (Signature of ota Public-State of FIffrida U (Signature of No Public-State of Flo da) Personally Kn OR Produced Identification Personally Known OR Produced Identification Type of Identificat Type of Id ep4tfikption Produced Produced ` Commission No. (Seal). Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014