HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 110-113 1 q Permit Number:
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Planning and Development Services 5T. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: El
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Site Plan Name: Block No.
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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:
Cost of Construction:$ cc) Utilities: _Sewer _Septic Building Height:
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Name Name: QftlS
Address: Company: C—
City: F�-- 1'nn 1 ere State:, Address: \ 1_\
Zip Code: ?)�Aq1`5
` Fax: City: l- I�\\ of e— ,` State:R
Phone No.^�� —~i ��� 1�c�� Zip Code: .:)`-igC1n� Fax: �--1( VLAV�
E-Mail: Phone No L-v1
Fill in fee simple Title Holder on next page (if different E-Mail�(�(`(\2S\f 11.'C17 1C� �1
from the Owner listed above) State or County License _� Q
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.
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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: 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign t e of Owner/Lessee/Contractor as Agent for Owner i ure f Contractor/License Holder
STATE 0 FLORIDA STATE OF FLORIDA
COUNTY OF 5�, �-yc�@ COUNTY OF 5h'• Lac�e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this\day of 20,M by this�.)�day of �M20VI by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L' Produced
IE GIVENS
• n ANNA MAR
(Signature of Notary PubY_--State of Florida ) ter- > (Signature of N Fir: 'b 'U Ster16,2020
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-- Np is n �o`c Public Underwntets d
Commission NoG�rO D N �ION#GG02.202 Commission No. d-�e dm N Notary
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REVIEWS FROG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
PTEIRCOU REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7