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HomeMy WebLinkAboutBuilding Permit Application i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Ypos Date: Permit Number: ocrn _ 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: -,�x .r -� cru# �' i ��' roar m - ft - PROPOSED INPROUfEMENT LOCbA# ION. ", ti Address: dG yeen It)n JQf'r v' Legal Description: Property Tax lD#:_ ODJO• � Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: .F'A;, i'�a;a;`�"r, �;,v?i h�#„ ±a �. 's .;*4-•*-a..±*.P .a3, . 30 t ; ON'.`0 .. , x e rr, D O .b eA f'r r q d,l-k-rr o F' r„ ' n # -��g.g i .{C4,N5TR=�UCTIOIINF®RM;ATIO.N- fg� � ,a �� a ' a _ `%-•hvk, @And'�em 9.,. u>m1IM..e`a.,t#at YBk�.#i':'9E xc'.� a q.sa a.::of w tl41a.. X1'1 P�.-ar., F�4 z *h, ��^:1'a A 4<`„.E 9S o. 4sk;.t t If h y°.- a.,*. Additionalwork to be pertormed under this permit-check all that appy: i _Mechanical _Gas Tank _Gas Piping _Shutters J _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ I co Utilities: —Sewer _Septic Building Height: i AWN 5-�3 9 �-�.4 a � �'' :'a �*�a �� It",r ��hw� i�- �-rte AWNERM-S-9 9 �e � :�. sky � CON°TRA OR s� 9 x R$huwMe� ... Afi;. .mm ,.f.. � ,,r Name "1 Lrl q (S7y ldl G �1 Name: &a_ra� 6so Address:73_q6,'/ tf( A_(-4(ia-n LA.-ts k/r(-'' Company: City: hr�- S7, State: Address:/�&Q(o arn1 d�r•��` /�'Ycr� Zip Code: Fax: City: Rn, pre!'C-e- 1 ' State: >� Phone No. , TUD — j/ 0..3 Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page (if different E-Mail7_f0V '6C--1herL, Cd�l from the Owner listed above) State or County License e C—G Jam/ la�S� i If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU`PPLE�I\IIENTAL-CONS1'R�l1CT" 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 Ow e /Lessee/ ontractor as Agent for Owner Signature of Contra or/License older STATE OF FLORIDA STATE OF FLORIDA COUNTY OFCOUNTY OF The forgoing instrument was acknowledged before me The forgoing instrurlient was acknowled ed before me this�day of 201(a_ by this—V—day of 2t by al _ (Name of peAbn acknowl ging) (Name of perso cknowledging) 4nAitu�re of Notary Public-State of Florida Whaturie of Notary Public- tate of Florida) Personally Known OR Produced Identifications Personally Known OR Produced Identification Type of Identification Type of Identification roduced Produced Commission No. (Seal) Commission No. (Seal) e ....o SHAHN INANotaryksn, REVIEWS FRONT 7,� S R\'/1$© R7MPLA S VEGET N Ar Ec- tVECOUNTER �/ N par EW— pate kkl W REVI Expire D M C �i9 J -&W 177249 °i Bonded thcou h Nati nal DATE �;F. p�,� Commission#FF 17249 A RECEIVED Bo deddhrou hNatioAry Assn. DATE COMPLETED ev. 7