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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO JMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / Date: /• /• / (0 Permit Number: / y 06 O 7" RECE Building Permit Application . Planning and Development Services JUL -'_7 2016 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: To Select from dropbox, click arrow at the end of line PR_®P'®SE® MPR�®VENIENTLOCATIO'.N "� Address: (DO��� I)(- QP FfQIP Ce_ ft_ Legal Description: Property Tax ID#: Lot No. I Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Y*�.,_ ib ;= T 7`t' -'moi Y � ��� .r�•4°.�',�+- % . -"$�"4�'y a3 -�`� ` "�a.Yom'S" '.i• �`d", ' a,p,2i d t iSx � �k �a z ,gym�k`��i ,�9 2 't�, � ' co • itiona wor o e e orme un er t is permit-c eck all that appy: 1:1©HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors Electric 0 Plumbing Sprinklers 1-1 Generator Roof Total Sq. Ft of Construction: SFt.of First Floor: Cost of Construction:$ �.�v v Kk Utilities. _Sewer Septic Building Height: ' '`"'N_ 'br a .,F t',*a -7 t r a %�.-z.F x } t 'f` 'v* "5.' , J a ®VV1lN,ER/LESSEE- � , r"CONTRACTOR f Name Name: Z(, Address �� (V �1�iT�ll ( i�( I' �I Company: r -} S l City: �p� fUCa rY 1 �� r- r, State: Address: g Zip Code:Z1—W I C) Fax: City: State:yZ Phone No. Zip Code:3��-1�� Fax: ,, I' �-6?-1 E-Mail: Phone No co-1 LJ ce Fill in fee simple Title Holder on next page(if different E-Mail: 0-oanl • ccfy—\ from the Owner listed above) State or County License:One 1R I c�Isg 1p If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. Sl1PPL�EMEN°TALC 4 NSTRU�?CTIQN�LIEN LAW IN,FORMATION � �� ,n i� ���� `���� �� s�.xs,r :' �,.&,.� '�°, :.e>����Y�u�n xk„ ' z�"•:,? n� ., . . ':,,t a ..,. � h�� r a�, x,�,.�, � _,r� °"�,'«.`a. z y� 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: 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. s _Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FL I�ID_A STATE OF FL I A COUNTY 0; ��� CSL�_(�_ COUNTY OF � Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this—day of I 20�1-g-by this�day of 20 by (Name of person acknowledging) (Name of person acknowledging) Alz (Sigfiature of Notary Publ' -State of Florida) (Sign ure of Notary Public-Stp a of Florida) Personally Known _OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No.OES)a U (Seal) Commission No.ff 0\9 - j+ CYNTHIA CLAY MCNAB •,,y„ THIA CLAY MCN 13B ' ��• •rfi _+ MMV COMMISSION augalml: Y COMMISSION#FF981289 ['-"kv*6W,',.—EXPI'RESApf]112,2020 Revised 07/15/2014 EXPIRES Ap i4o7s e' ,rll 1a.2020Floridallots swv+e.con REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS