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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ID, Permit Number: RECE14'17D DEC 0 u 216 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: OCL PROPOSED I'NPNOR )1 IENII LOCATION: �� CL ---- // Address: �YU S /USC �v t6C-J �QG<e Legal Description: Property Tax ID#: 3d ^ eo 6A 6 <) Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Sider Left Side: DETA ED DEQ-SCRIP ®'N © WORK; '16 Xce CL Ar 6�J/%d ROOM ill IN -OR+MATION: itiona wor to a pe Orme under this permit—cheCK all 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:$ Utilities: —Sewer _Septic Building Height: OW'N5R/LEhS�S-E CONT ACTO Name ✓ �,'_: eC a.',`'u-, o• �S Name: Address: ��1os or��_� Company '' �n, d..�1. ;eJnr0i .M•�e City: (70—C-1 /111�cce State:_0, Address: Zip Code: Y Fax: City: ' State: Phone No./ �SL! 6 1/��� ��s'� Zip Code: dol�i�l Fax: E-Mail: .�✓c�,Ieez-16 SG %yl,S/z—D pMc/Ga"` Phone No �7a2 37U'� yl9 Fill in fee simple Title Holder 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. FSE PP1EM0NTAL C®NSE aCTION IEN W INF®RI�/IATi®<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 commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The fgrgoing instr ment was acknowledged before me The forgoing instr ent was acknowledged before me this '� day of �C. 20%6 by this�day of �C ,20Aqk by k <N-0,i C"�>' \-N O q--1 IL"', c\fNC:s 1`c� " tN (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary ublic-State of Florida) (Signature of Nota Public-State of Florida) Personally Known OR Produced Identification Personally Known O a i n Type of Identificatio Type of Identi ' DS pNjj , IEGNENso2s Produced 4 Z— Produced .��"�••{ COMMISSION#��� r�s,2a2o IE GNENS NobrY public Under milers Commission No. CDM�N#GG022o23 Commission N �s.zo2o i►3 EXPIRES Dgcem Ueiwrttors ;;� �%EO, Bonded REVIEWS FRO SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE COU REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.