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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE 1 FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( J Date: Permit Number: CSZ4 f sus`OF 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: PR�©POSED INPR®UEMENT LOCATION: Address: Z2 15 53 07- Fo r `T Legal Description: (KI mta?- Property Tax ID#: *'141 `ZI•- -7o-L - ©01R- 000-1 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D TAIL D ► C QIP I®'N nF W®RK• rA Lr 1CON,S�TRCTION INF®RMATtO Additional work to,be pertormed under this permit-check all tat appy: chanical _Gas Tank _Gas Piping _Shutte'rs _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ k b'f) • D d Utilities: —Sewer —Septic Building Height: ., MWAER/LEzS�S CO RACTIO Name M lel axj4 Ao&wI S Name: row tT-ty Address: as b r') 5? s"-(— Company: w,, z r-F '-mac_'C r-&C p y, s City: ('O r4Q?� State:r=4_ Address: p Lt. -g 3 1 ��r�L ✓t��. Zip Code: 3Li �,�' Fax: City: jeer: &-I t_J L e Stater Phone No. Zip Code: 2!46g2 Fax: E-Mail: Phone No � x Fill in fee simple Title Holder on next page (if different E-Mail ie ,. S"n-. r- rt �('er✓�� 'S� �.yiAi` ., from the Owner listed above) State or County License 60 I-To Alf &772 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEM TAL C«ONSTRUCTION IEN 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 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 recordin our Notice of Commencement. r-- Signature of Owner/Less e Contractor as Agent for Owner Signature of Contra cto /License Ho der STATE OF FLORID STATE OF FLORIDA COUNTY OF L,ls�c�'� COUNTY OF The for oing instrum was acknowledged fore me The fo g instr en was acknowledged before me this day of �'�V1 20 Ity this Jgay of 20M by r'�A uo�rd S (Name of person acknowledging) (Name of person acknowledging) (Signature of NotarY Public-State of Florida) / (Signature of riotary Public-State of Florida) Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Identificatio / Type of Identil ti n Produced (� Produced Commissio- ANGELA M H ��� f " " (Seal) UFF ' state 07 ) Commission ALd.,���taRYA'•,, Pba�;'•. Notary Pu 234730 ANGEIq E , 7 201S *;=N* Y Notary pUbtic_ M kUF ? Commission#FF "oS My Gomm. Ass . "oF aof °°� MY o; on#FF lorida r OP' d throw h ational NotzrY��,. ., Flo 10 g ffAETdf7 s 27,20, � GROVE REVIEWS'-ig;;;,;,.�f=ROdd� . N'��" SUPERVISOR PLANS VEGET'l�`Yf�Fond� - - °�COU�V—TER REVIEW REVIEW REVIEW REVIEW. "`--- - REVIE'V1 IA10ta X201 IEW DATE RECEIVED DATE COMPLETED Te—v. 7/2014