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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: p SEP 2 RECEI'." 9 2016 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: PRCIPbSt tNP�ROVEMENT LOCATI(3N , Address: a�©� e01l/gt S Legal Description: Property Tax ID#: ay O)l Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: IF DETAILED ©ESCRIPTIO OF WORK• e e4 //9G� E , „is�iv�a c�ye�-h �4 -le-C-rim.. S'F e/ice KrSetl` 'fNhS�Oh Dh �r'aTx .Sea-✓ice ��oD . ,.•' ,; CONSTRUCTION INFORMATION: Additional work to be performed under this permit–check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors i/Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ o Utilities: —Sewer —Septic Building Height: OWNER/LESSEE• CONTRACTOR Name /�Y a`!a/„ala �aJjzso�, Name %_ !Q .e /� AddressEag` '`n�/yo / Company: 7�r►'ym_flsD�� City: ford` ",dpi�r�e State:�L Address // Grq.�tso1 St: Zip Code: FaX City: Stater Phone No. Zip Code: Fax: —.;z.2,f E-Mail: Phone No .316, Fill in fee simple Title Holder on next page( if different E-Mailer//vlo�e rT/ctJ 11 Qui DO ecox-7 from the Owner listed above) State or County License 2E C— 0002 72 3— if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CfJNSTR`UCTIQN LIEN LAW INFORMATIQN' 3 DESIGN ER/ENGI � NEER: 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. _ J Sign t of Ow Lessee/Contractor as Agent for Owner Signatu a Contractor/License Holder STATE OF FLORIDA STATE OF FLO�IDA COUNTY OF COUNTY OF L The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledge before me this� day of �� 20� by this.?A, day of 'A-t 20 ka by o,-A �'ChOmQ�Q"V1 (Name of person acknowledging) (Name of person acknowledging) . 1 (Signature of Notary ublic-State of Florida) (Signature of Notary tbllic-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification L Type of Identification Produced '- Produced t- L Ee �p23 DeArIW► 1 q i2o23 Commission No. � p M IpN s 2o2o`e Commission No. MyCpN ber1s.2o2o ..•....,. C m t nm cs • • IRE Undary ti' ' 1 p1Rtis Pub�cunde +: `- lhtuwatlpublie o� '%i: otary %°;• .Q: Bonded ia., 'Q°� gots "•••• .••` REVIEWS. FRO "'' SUPERVISOR PLANS VEGETATI SEATURTLE MANGROVE COUNT EVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014