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HomeMy WebLinkAboutBuilding Permit Application i „s All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED QQ 22 Date: Permit Number: I Ito O + 030S BuildingPermit A licat pp iron Planning and Development Services I' 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: PRC3P�SED )NPROVEMENT LO.CATfCN. Address: SLA, e v� Legal Description: i Property Tax ID#: ��G a g� G'L/f "-�oc'�-'7 i Lot No.� Site Plan Name: Block No. 4 99 Project Name: Setbacks Front Back: Right Side: _Left Side: ,I a � k � DETAILED DESCRIPTIQN OF WORK a '3 s'f ��r12-,c -,�S - �14 �gid�e dT`�jtr>se I CQNSTR O CT(ON INFORMATION �,. - �. Additional work to be pertormed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Electric 1-Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ Utilities: —Sewer —Septic Building Height: RI J, ONER/L V1lCT ESSEE! CUNTRAQ r, . . �. _. . _ Name Nam : Address: e"'7/1 7(- A Compah r: 11�2ee4 City: � !d-av��!yy /9 State: Address: Zip Code: Fax: Cityi262/5'/ xc�af'e I� State:/__�t_ Phone No. F4:5)?' Zip Code: 3W�;� Fax: 9/7.7 SSS E-Mail: Phone No 2 _340- - Fill in fee simple Title Holder on next page( if different E-Mail 477`./uel from the Owner listed above) State or County License -11a 0 �I If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:W _Not Applicable z 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 commen,dng Wrk or recording our Notice of Commencement. ./e �2 V ign! re of Ow /Lessee/ oritractbr as Agent for Owner Signatufe of Contra " r/Licens Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF -.h., COUNTY OF s The f-0,[going instrument was acknowledged before me The foing instrument was acknowledged before me this ,day of Zap& 20L by this�day of���20A by (Name of persYn acknowledging) (Name of person acknow dging) 4( 61gn�NtiuLre of Notary Public- tate of Florida TS59nature of Notary Public-St a of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identificationa Type of Identification Type of Identification Produced Produced V'L 120714\40 Commission No. (Seal) Commission No. ;=oPaY , al) LASHAHNA IN Notary Public-State of N�AM N: *'S My Commtoric Notary rP,u,blic-Stat of Florida %;;or F oa"I Commission#FF 21.20 REVIEWS FRONT © � iVl@RD c 2p,7L,Q VEGETATION SE .IfFL IiAM� 49 M� ° nal ota COUNTER E,9 ao: �Cnlf�l€�uyn#F 1R 0AE REVIEW REVIEW `�IZEVfEW Ass DATE Bon e RECEIVED DATE COMPLETED ev.