HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: �J 3 Permit Number:
=RECEIV7ED .Building Permit ApplicationPlanning and Development ServicesBuilding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
W7P+USE� ! - RR(+1.ASIMT,FEN OCATIO `
Address: 01 N -39-N ST. •-
Property Tax I#: Mog- y - 001(o- OM- 1 Lot No.
Site Plan Name: Block No.
Project Name: WS • MOORE.
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator J Roof 5 ' 1`U Pitch
Total Sq. Ft of ConstructionA-u0 I Z Sq. Ft. of First Floor:
0
Cost of Construction:$ ��. Utilities: . —Sewer —Septic Building Height:
Name CAWA Name: t U$ VIM FIV% G sv
Address: N .. CISR LI'S
5
Stater-i' Address �, 0 -
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i.JA&A,,
Zip Code: Fay c City. �1 ' ,1•' State: F
Phone No. ` '� ` •• " ,' Zip Code`: .' Fax:
E-Mail Phone No' �DZZ
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 330
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
1:111, l.li 1ti1 �. ' RltillA C9I1•
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR kENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent or Owner, Signa e o Contractor/License Holder „
STATE OF FLORIDA STATE OF FLORIDA
M
COUNTY COUNTY OF
OF
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The forgping instru t wa cknowledg efore me
The or oing ins nt was cknowledgbefore me this day of 20 by
this 1 qday of 20 by p
Na�Ap«Fmaking
to ment.
Name of person making statement.
Personally Known Produced Identification
Personally Known `�OR Produced Identification Type of Identification Produced
Type of Identification
Produced
-, (Signa ureo,Notary.P.ublio-So
tat ,:,lorida;) .
(Signature o otary•Public tate.o .I H "" Commission o 9. (Seal)
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�Notary Public State f Flonda rCommission No. '� I)MarybellMaiG 2 0975 G'27097b'
Expires 10/24/2022
REVIEWS FRONT ZOMNG:; ��" iSUP,.ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE t
RECEIVED
DATE
COMPLETED
Lv7/19