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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� Date: Permit Number: `--� v 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: PRCC PQ1 D I,Ni'R01% NIENT Address: i gas k 1-As t i S i zea: fl _1 Legal Description: SAVAu, A 0.]u J3- !?JK1 0I[E - NY,`L L a'T 23 Property Tax ID#:3V',_2S J01 CAnl0"7 0go 3 Lot No. 3 Site Plan Name: Block No. v� Project Name: Setbacks Front Back: Right Side: Left Side: AILED QE � z J <. I s CONSTRUC [0� INF©RMATON � k a pa Additionalwor to a performed under this permit-check a that appy: _Mechanical _Gas Tank —Gas Piping _Shutters —Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft'of Construction: Sq. Ft.of First Floor,: ' Cost of Construction:$ ��S V.01 Utilities: _Sewer —Septic Building'Height: O R/[ SSE ' CONTRA OR _ 31 �4 y Name J-o V I S i4U0 a1-A D M me\ Name: � _xam Address: Za-%:)- P &:S .4,59,j5 , '.,c Company:U Mt.3 e- City: W S\- L arc.. State:r:L Address: -5. Qoz'cc .X sn Zip Code: 5�. Fax City:�p\� State Phone No.J'7,_'X 333 2y:6Q Zip Code: !,'20R ___ __ Fax:--- E-Mail: ax:"E-Mail: Phone No ,_7X_71! VV Fill in fee simple Title Holder on next page(if different E-Mail WA�!t- Scl e �' �.'�� . Coy►-a from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEIVIENTAL CO:NSTRUCTIQN LIEN LAW J3RNIATIQI 3 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 ofnerf Lessee/Contractor as Agent for Owner Signature of ntractor/License HolderOv . STATE OF FLORIDA � r , T STATE OF FLORIDA COUNTY OF CII G�� COUNTY OF Co�_— The forgoing instrut was a knowled efore me The mg instrument wa acknowledged before me thiay of 20� f•ry this day of 20�by (Name of perso cknowledging) (Na person a knowledging) ti. (Signature of Notary blic-State of Florida) (Signature of Notary ublic-State of Florida) PersonaEe +� i'•, (�PIwtimlidentif ation Personally K i0.t °A�' Ry � �4YI ttificati e tar PRA( -state of Florida Type of t guibIi - t of Florida Type of Iden i 3 Commission#FF 234730 fc _t��. Cissio 234730 Produced Produced=.. . a = 2019 ,,OFFI y 27,2019 v Bonded through National Notary Assn. Banded through National tar ssn. Commission No. nom. Commission No. REVIEWS FRONT ZONING _ SUPERVISOR PLANS V G— ION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REQ IEE' REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. j