HomeMy WebLinkAboutBuilding permit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a -1 l� _ Permit Number: O�
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Building Permit Application'St.4 9,0 ?0?°
Planning and Development Services CIO 4 enr
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT,LO.CATI,ON .m - °- _ w
Address:
Property Tax ID#: 1 ` �� I — — ���— ` , Lot No.
Site Plan Name: /^� Block No.
Project Name: n W o f1/ �/f l
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DETAILED D5
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hrCONSTRUCTION INFORMATION'°
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
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_Electric _Plumbing
�/� _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: ) LJLJ Sq. Ft. of First Floor:
Cost of Construction: $ �i�._ Utilities: —Sewer _Septic Building Height:
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®WNER/LESSEE GOIVTRACfOR
Name Irl _ Name: cJl
Addres : , Company:
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City: I ( State: Address: !
Zip Code: F : City: State:
Phone No. SflZip Code- Fax:
E-Mail: Phone No
Fill in fee simple Title Holder;on next page ( if different E-Mail'19ntl KR3rI nC
from the Owner listed above) State or County License 3l
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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SUPPL WtNTAL.CONSTR,UCTION LIEN LAW INFORMATION '{
1 DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address: II
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicabi e
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 NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ure o ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STA OF FLORIDA _ STATE OF FLO + '
COUNTY OF c „� . . �,,,� COUNTY OF . l i �t✓I
The forgoing instrument was acknowledged before me The r Ing ins t s a <no I dg�yi afore me
thisa�day of` � 20 3 by this ay of V 20�_(�y
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 Produced
Signature of Notary Public-State of Florida ) ( gnature of Notary Public-State of Florida )
"I..•'' SUSANLAFLEUR (Seal) Commission Nd - — ;�""'' : �L•HOPKINSCONN LL f
Commis :*. ,; MMISSION#GG 940
COMMISSION#GO 356204
EXPIRES:February23,2o23 �+� Q' EXPIRES:December 17,20
••XII edThruNote PubkUndetmiters rU icUnde
REVIEWS FisUPERVISOR PLANS VEGETATION SEA TURTLE ` MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE I
COMPLETED
Rev. 2/7/19
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