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HomeMy WebLinkAboutBuilding Permit Application W All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: .2_-Z.L' 10 Permit Number: fE FEB 2 2. 2016 Building Permit Application PEW11ITTING Planning and Development Services St. Lucie County, FL 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: PRUPOSED INPRQUEMNl'I.00ATIDI: f Address: ,L 3c Legal Description: Property Tax ID#: Q ti Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED E�SCRIPTI©N 0f V1/ORK: u C"©NSTRU'CTIM.N 11 N' Additional work 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: v Sq. Ft. of First Floor: Cost of Construction: $ / �t/ Utilities: —Sewer —Septic Building Height: O�1NN�ER/ILE�-SSE: „ CENTRA Y OR - Name OL Name: Address- Company: City: -State: L Address: Zip Code: Fax: City: State: Phone No. ^S – Zip Code: Fax: 4 E-Mail: f, 00 Phone No Fill in fee simple Title Holder.on next pa °(: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. DESIGNER/EN6INE� kf—A tot Appft "ble MORTGAGE COMPANY: Not Applicable Name: �_ - � Name: — - - -- � �_.._. . ddress• dre City: "; State: City: State` Zip: Phone;''` Zip: Phone: FEE SIMPLE TITLE HOLDER:. _Not Applicable BONDING COMPANY: lNot 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 1 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 abother 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 com a cin A work or recording our Notice of Commencement. I le Sigt ature of Owner/Lessee/Agent Signature of Contractor/License Holder,. . STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before.me this� day of _ ,20--6 by - this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Ident�f�ca ' TVpe of Identification Produced �l— Produced LASHAHNA IN6RAM `oa;��,, Nota po Ic_State.of Florida Commission No. ;2. • yy a� Commission No. (Seal) s My c m , xpires Dec 20.2018 Commission.#FF 177249, Iijili 0 REVIEWS FRO O ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE + - COMPLETED ev.772014