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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �[ Date: Permit Number: (0 E 1� Q/ot;� �I n r 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: PROPOSED INRROVEMENT,LOCATfO1V Address: 5_130 /V US Mt)y 77;77—� . r2f� �, 3/ 2 6 Legal Description: %0 Property Tax ID#: d o 07 s e 66 Lot No. Site Plan Name: Block No. Project Name: trD4G•r.�� � � ruJroCr���,.r Setbacks Front Back: Right Side: Left Side:. J, DETAILED DESCRIPTION�OF,.WORK = U r CONSTRUCTION INFORMATION ' . Additional work k to be,performed under this permit—check all that appy: Mechanical _Gas Tank Gas"Piping _Shutters' _WRidows/Doors Electric _Plumbing _Sprinklers _Generator Roof A Total Sq: Ft of Construction: c adT Sq. Ft.of First Floor: Cost of Construction: $ 0(�2Co.ao Utilities: —Sewer —Septic Building Height: OWNER/LESSEE =CONTRA Name rr4 E" _ �Q�, Fe�", Name: Address: 1 ' Vic— ';oma y Ct M7711FW Y Company: City: ter State: Address: Zip Code: :33 0 4, 2 Fax: City: loo�1 ,4. fes- State: y Phone No. 7621 -- — Revs Zip Code: 99-6 -AFax: E-Mail: e�",F' A &-41140- IC-/eScad sCP01 Phone No 43Fel Fill in fee simple Title Holder on next page(if different E-Maili10101� VAe •8f'yl,L ACV. ao,�, from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 'SUPPLEMENTAL CONSTRUCTION CION LAW INrORMA l0N DESIGNER/ENGINEER: _ Not Applicable hMORTGAGE 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 No 'c9 of Commencement. 40�010 V Signature of Owner/Lessee/Agent a of Contractor/License Holder STATE OF FLORIDA / ` STATE OF FLORIDA , COUNTY OF COUNTY OF ctc, I The forgoing instrucknowledge fore me The for oing instru nt as acknowledged before me/ this day oft s a20y this day of 20pby r ©*­,o A A , (•z)[:�,(�- 1 ,/ (N me of person acknowledging) (Ndm of person acknowledging) 4\ (Signature of No ry Public-State of Florida) (Signature of Nota y Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Id Type of Identifi i (�� Produced FF Produc' �J r; Notary Public.-State of Florida � �A�•, _ o e,•_ ANGELA M HUFF e CommissiohNg.� 'Commission#FF�S��p Comms o's My Comm.Expires May 27,2019 ;, • + •; tate of Florida Bonded through National Not Assn. Pca,,M CoCmmisslon#FF 234730 M a •"� hrou REVIEWS FRONT ZONING SUPERVISOR PLANS VE'�iE�AP MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.