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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date. / Z� 7�/(� Permit Number: Va\Q�- 1 13 RECE117D DEC 0 7 2016 III_ _ 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: P'R�'P®SED INP ' OUEMENT LO ATIO'N(: n �--� Q Address: Legal Description: Property Tax ID#: �`��15 ' ��-- dds — 6Qd—6 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DfTA LED DE�SCRIPT ON a W0 ('r(.9'�►' CGL: r . �� � l�i9 a � GN: �-�/�' � CONST OfCTIO W I I`NFQRMATiOMtis Additionalwork to.be performed un permit—check all that appy: _Mechanical '` _Gas Tank _Gas Piping _Shutters _Windows/Doors _'=Electric umbing Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: !JO Cost of Construction: $ Utilities: _Sewer _Septic Building Height: ©V : ER/LEASE CONTRACTOR: Name `; !!S`.rsivriJ. �/, 5: ,::;_:::....::. Name til � Address 310 rV,i�/f1 ,J���_ Company City: ,er — '�r� "..r� State: /C� Address: Zip Code: ��' Y'!2 Fax. City: ,c V7-- State: /Ec� T- !i: Phone No. 7,P3 4�� G/ Zip Code: / "Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail 1"1_v4z0 from the Owner listed above) State or County License � 3 X1-5 If value of construction is.2500 or more,a RECORDED Notice of Commencement is required. S,UPFL MENTAL CONSTRUCTI®N LIEN LAW INFORMATION 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 thepermit 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 n attorney before commen,cing work or recprding your Notice of Commencement. i Signature of Owner/Le ee' ontractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORID COUNTY OF L w c-1'�, COUNTY OF t)c'!S� The forgoing instr ment was acknowledged before me The forgoing instr�.{�ent was acknowledged before me this�_day of �C 20� by this day of i��c 20_\_�o by past c ick (Name of person acknowled ing) (Name of person acknow edging) (Signature of Notary PubM--State of Florida) (Signature of Notary blic-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Id Type of Identification NS Type of Identification 1EGNENSo Produced L L 1EGN 0123 Produced L L M� itGGW22301A2p QIP {BGG Zp2p MtdAS X16, 10� Commission No. — .. M.�G ��Sa�� wV°dem Commission No. 'Wks" d _���" '':� �p1R�N�tacl4'i9 �`�+ .. Q B��dZ1+n► REVIEWS FROM ING SUPERVISOR PLANS VEGET ION SEA TURTLE MANGROVE COUNT REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/21014