HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO M�1UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��" Permit Number: J Cal�
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Building Permit Application a ,
Planning and Development Services
Building and Code Regulation Division d o
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address: Sca
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Property Tax ID#: �O Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work-to-be--per-formed--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:$ d O .G�� Utilities: —Sewer —Septic Building Height:
Name I MrCAE 5 Name:
Address: JJcJ40R ✓ Company:
City: 'F � f GC State: L Address:
Zip Code: ,t.0( 1c< Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from.the Owner listed above) State or County License
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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DESIGNERANGINEER: —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 thepermit 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 1 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 YO R'LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Si at a of Ow er/Lessee/Contractor Agent for Owner Signature of Contra ctorjticense Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 4-
�- ' ._ COUNTY OF
- he-forgtoing ir-strume--nt-was-acknowledged-before�e. T-he-foFgoifig-iastrumeif-wes aei<ne tedge&befere-rit
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Name of person making statement. Name of person making statement.
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentificatiType of Identification
onProduced Produced
(Signatu „o ar Public-Stat of Florida) (Signature of:Votary Public-State of Florida)
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Commis 4 ELLENAUG a Commission No. , (Seal)
an `= o lorida-Notary
Compublic
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Octob r
REVIEWS UPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER R REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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