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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ''^^ Date: a 1-95 (D I L.O Permit Number: � tJO� 7 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: PRQPOSED INPRQUEMENI" L©CATIQN: Address�i,pm l� 0ail rrle�('e Legal Description: LDT (TEL", -49T kftJaoo?A-121_ tjio j r Mcg '1 QceorctSn c -Ta n.�e ?k--' 2smcmema c'e ca.-A e-A I�Tlat 600 K I 'Dg'-e 13 of JJX Fc N41 Ire-&A i05i Lcu iP cbu Property Tax ID#: 00 I (007.022Z .-U Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESC IPTION gop WORK: 77 C© STRWCTION INFORMATION: Additional work to Ue-pefformed 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:$ 12 oo CCI Utilities: —Sewer —Septic Building Height: OW" NER/LE�S�SE: CONTRAC ®R: Name Name: OtyRex— Address: LJ -ems- Company: City:�'�" e c'L� State:� Address: Zip Code: 3 J!5 1 Fax: City: State: Phone No.C23D 334 • CD9Dy 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. MINPMWE EN 'L CONS 1'R CTI.©N 1.1 =N LA1IV Nff=OR NO 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 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 TT10:) NER:Your failure to Record a Notice of Commencement may result in your paying twice for improvemeour property. A Notice of Commencement must be recorded and posted on the jobsite before the fa If ou intend to obtain financing, consult with lender or an attorney before comme cinor reco d'ing your Notice of Commencement. c Signature f O n r/Lessee/Agent Signature of Contractor/License Holder STATE OFF ORIDA STATE OF FLORIDA COUNTY OF COUNTY OF Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this ) day of 20 f(o by this day of 20_ by (Name of person 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 Type of Identification Prjoiu5cead3 stake atMloctda Produced S 2p19 Commission No. .•��'I'J'�-, Notaty�9bw,ias0eo2�2gg Commission No. (Seal) GO tssion#FalNotacy Assn• *Qe Comm aC�on REVIEWS FR 'rt""""' eo NSG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COU > REVIEW REVIEW REVIEW REVIEW REVIEW " REVIEW DATE RECEIVED DATE COMPLETED ev. /2014