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HomeMy WebLinkAboutBuilding Permit Application i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RECEVED . . w.;.,.. Building Permit Application �1 l 2016 Planning and Development Services PERMITTING Building and Code Regulation Division St.Lucie County, FL 2300 Virginia Avenue,Fort Pierce FL 34982 —' Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _ PERMIT.APPLICATION FOR: 1010 POSED INPR UE ENT L�CATIO'N: Address: C60te �A_ e EL 3ygS f� Legal Description: Property Tax ID#: 1 319 —801 "C009'-- 00©— Lot No. Site Plan Name: Block No. Project Name: 04 Setbacks Front Back: Right Side: Left Side: Y D'E AILED DE�SGRaIP I�'N � F OR+ CONSTD 9,1 C f0`N INF(YRMATION: Additional work to be pprtnrmed 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:$ �DID Utilities: _Sewer _Septic Building Height: M �ER/LESS E: CONTRA TOR Name i' ae�- Do SOI Name: ) 2r�e -Al e' Address: F_-&Jf a.Vf. Company: .Svillxe. C-(+Y- C. ffi City: � Pj 2 rc_� '` State: f=L Address: �_T�() 6 kee CVIo I�eP Zi Code: ) Fax "' Cit " f p 3 U�� -;�. y: c-T I�^erCe_.� State: Phone No. a . Y.°..: Zip Code: F x: E-Mail: Phone No 02 17 j4 Fill in fee simple Title Holder on next page (if different E=Mail e -:1- : "Cta from the Owner listed above) State or County License-'C C 0.3a Toa 08 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU!PPLEME�NTAL CONSTRU"CTIO'N LI�E�N LAW INf'ORMATLO'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/Less a/Contractor as Agent for Owner Signat re of Cokractor/License Holder 7 STATE OF FLORI! STATE OF FLORI COUNTY OF COUNTY OF The forgoing instrument was acknowl dged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of ,20_ by r/ �21r i C (Name of person acknowledging) (Name of person acknowledging) (Signatu a of Notary Public-Stat f Florida) (Sign r - f� otary Public-St of Florida ) Personally Known' OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. Aka .``tiPR�nVB' •,,.�a���,, LASHAHNA INGRAM =a�. � Notary Public-Storida •_, oar u isMy eofflm. ate o o Ida s ¢ _ : ' s' n# 49REVIEWS FRONT ' ' �y Co U � s�'R' 01 NS VEGET ��FAo q 9 E oNati COUNTE Corr mis 177249 R VIEW REVI DATE RECEIVED DATE COMPLETED :Fe-v-. 7/2014