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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: REcEIVED Building Permit Application JUL m 5 2016 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: 0 �I cctr i cel PROPOSED IN!PR®UEMENI"LO,CAT N'• Address: Legal Description: Q � � �� /°` �,w Property Tax ID#: Q) �3- 4"/9 —,570 0/K —ad9-eJ Lot No. Site Plan Name: Block No. Project Name: ' Setbacks Front Back: Right Side: Left Side: DETAtLED D'E=�5 �I'PTI®N OF 11VORK - _ CON` �IN ®RMATION: Additional work to be performed under t is permit—check all that appy: _rchanical —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: OVV�N R/LESS E: 4 �C.®N,�TRMgEi : �i Name C 1 iName: AddressN�61 Company: City: __� L-LG4�-f State: r ; Address: Zip Code:`�3­ygFax:n City: State: Phone No. �5� " EJ7 Y/ Y,;7' Zip Code: Fax: E-Mail: 3G I=f Phone No Fill in fee simple Ti a Holder on next page (if difkAef Vt E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,6 RECORDED Notice of Commencement is required. SU'PR'LEMENTAL C©NSTRUCTIQN LIiE�N LAUV LN'F®RMATI:� 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 thepermit 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 Omer/Lessee/Contractor as Agents.Wipj Signature of Contractor/License Holder or_ A-i;.'- STATE OF FLORID STATE OF FLORIDA COUNTY OF K COUNTY OF The forgoing in ent was acknowledge, befoa�r� 9 The forgoing instrument was acknowledged before me this day o 20ZV by o= this day of ,20_ by z� C 03 T v e a pV ..a A (Name of person acknowledging) a N (Name of person acknowledging) Signature of6btary Public-State of FI icla U (Signature of Notary Public-State ofEFlorida) Personally Known OR Produced Identification / Personally Known OR Produced Identification Type of Identification Type of Identification Produced ) DrR - ki(�, Produced Commission No. (Seal) Commission No. (Seal) ,r ra. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014