HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
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Planning and Development Services 1pe&\'&\�
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMITTYPE:
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PROPOSED*00 WN'T
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Address: tt Qcx
Property Tax ID M. Lot No.
Site Plan Name: Block No.
Project Name:
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OfIAWORK
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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 Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor: '0
Cost of Construction:$r
Utilities: Sewer Septic Building Height:
OWN
Name Name:
Address: Qk-J6 '2 Company:'
C i •1: State:� Address:
Zip Cocle'" State: '/
Fax:
Phone No. Zip Code: l Fax:
E-Mail: Phone No -'LnA I-
Fill in fee simple Title Holder on next page(if different E-Mail dcx�kcw -
from the Owner listed above) State or County License SZ 04
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If value of construction is$2506 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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
n 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 T E JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO'OBTAIN FINANCING, CONSULT
WITH YOU NDER TTORNEY BEFORE RECORDING YOUR NQTICE OF MENCEMENT:'
Sig a of Owner/Lessee/contractor as Agent for Owner Siet'yP6 of Contractor/License Holder
STATE OF FLORIP
STATE OF COUNTY OF � COUNTY OF O TNQ� (�
The forgoing instrument was acknowledged before me The forgoing instr n as acknowledgePefore me
this,-aL day of `10 ,20a by 20 rl by
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NaAe of Werson making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known_Z OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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to Public State of Florida
(Signatu of No I o$gll(R'i sa Girgado (Sig a re i 59
My Commission GG 285459 y� Expires 1 211 812 02 2
d; Expires(12/8/2022 'o1aF
Commission No. A* a �l Commission
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. -
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