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HomeMy WebLinkAboutBuilding Permit Application t All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: E�' �,� Permit Number: I LOU) . .. , , 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 INPR'OUEM NT LOCATI* Address: o �_O\nIA_C CDP���_�® I`�9---- Legal Description: Property Tax-ID#: �� PIL�� , �� — C7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Righti e: Left Side: © TAIWD ®'E�SCRIP IO'N ®�F 0d C®NSTRUCTI®N fNFOR,MATION: Additional work to be performed under this permit—check all that appy: _Mechanical _Gas Ta _Gas Piping _Shutters _Windows/Doors Electric umbing _Sprinklers Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Utilities: —Sewer —Septic Building Height: OW ER MV&S, EE: CONTR CTOR: Name r. Name: Address: \ ', moi_ t_ yt i2S4 Company: City: I ti� t C' ` State_ Address: Zip Code:I'-A `t 1� `�,_ Fax: City: State: Phone No. ` Sk2l, (1—`__L"sk7 Zip Code: Fax: E-Mail: -� Phone No H Fill in fee simple Title older on next page,(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. SUPP'LEM'ENTAL CO'NSTRUCTI®N LIEN LAW INF®RiMATI®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 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 commencp&work orrecording our Notice of Commencement. Signature of ow er/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FL RI - � STATE OF FLORIDA ` COUNTY OF 'k`A o COUNTY OF The f rgoing Inst en was acknowledged before me The forgoing instrument was acknowledged before me this day of M 201(f)by this day of 20_ by (Name of pers acknowledging) (Name of person acknowledging) 4 M�"Lm, , Sig ature of Notary Public- to of Florida ) \ (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Prod cedq Produced ' LASHAHNA 114 -Commission No. 'a��� B Notary����}State of Florida.. Commission No. (Seal) �� v r�'� _rnc: .a My Comm.Expires of 17 2491 • s fission "E nr r�° ` ended through ational.ola,y REVIEWS FR NI"'''_',x _2- NING'�r""''S IPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.