HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MU B CO PLETED FOR APPLICATION TO BE ACCEPTED
Date: " ��' Pern-01 Number:
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Building Permit Application NOv p� 1019
Planning and Development Services Depa�ment
Building and Code Regulation Division i permittlnck County
2300 Virginia Avenue,Fort Pierce FL 34982 t•Lu
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE R'NA06�
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Address:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
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Additi nal 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:
Cost of Construction:$ Utilities: __Sewer _ Septic Building Height:
Ct�NT�2f�Ci CSR s '
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Name _ yNam.e ._�
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Address W Company•_
City: StattlC Addrer,
Zip Code: _ Fax:_ City: _ State.'
Phone No. _ �� '– ,_ Zip Code:_ _T -- – Y Fax:
E-Mail: _ Phone I+la__1_ .. _
Fill in fee simple Title Holder on next page(if different E-M
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is i equired.
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:
City: State: City: State:
Zip: Phone Zip: Phone:_
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: — Not Applicable
Name:
Address: Addresses
City: _ City: -- .---------
Zip: Phone: Zip:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the wort:and installation as indicated.
1 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, 1 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, 9
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 COii MENEF.,'1'dE14T 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 IMTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S' re of Owner Tee/Contractor as Agent for OwnerHatt _of Contractor/License Hol er
STATE OF
COUNTYOFORIDA w �1 C UNTOYC FLORIDa.LJJ�t
The f rgoing ins u a ed efore me tthi�
ins ui icnt ledg efore me
this day of 0 by of _ 20 6 �Iby
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Name of r11,48 n
- -
pe son makr statement. Name of person ma ing statement.
Personally Known OR Produced Identification_— Personally Known _— OR Produced Identification
Type of Identification Type of Identification
Pro ced Pr duced
(Signature of Notary u ic-State of Florid (Si ture of Not i u lic-State of Florida)
STAL MARIE CRUZADO !1,, 1111111
Commission No. ��Q�l�SION#FF993217 AL IE CRUZADO
MY CC9 ^ Commission a _ _ M,,J PFF993217
=?�•. EXPIRES June 25.2020 :•: MY COMMI
Fbn x ot�7spP1
tG, IRES June 25,2020
(407138 153 --
REVIEWS FRO ZONING SUPERVISOR PLANS VEGE -015 _ RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW Rt VIEW REVIEW
DATE - _—------ -
RECEIVED
DATE -- ---`�_.._-1----
COMPLETED
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