HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ��, Permit Number 2!o 5-DO 5
.__.W Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PRQ tS D I PAVEMENT(OCATIa ra f
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Address: 532-4 q tp-cr hL'4J '70c4 C( c
Property Tax ID#: -���D 6-0 Z - 6 9,3 0 -` 4 6 - JL Lot No.
Site Plan Name: Block No.
Project Name:
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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:$ -4 6J5-0 0 G Utilities: _Sewer _Septic Building Height:
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Name t 1 �J I AkName: -Fob k,4 Le VJ 1 S
Address:. 3a Company: ;E�70 c ri C T1/1C`
City: T)'(2 r State:_/ Address: 781 (~61 v r, tGl (Inke- L:-")-,,?V
Zip Code: - C!�1 Fax: City- 12 1'C% Stater/
Phone No.(--�O),J3 -2 q /4 r L Zip Code: ��/ �� Fax., -7 77,5
E-Mail: Phone No '-12
Fill In fee simple Title Holder on next page(if different E-Mail :i N C b'1 G I21G i �C di7
from the Owner listed above) State or County License C:
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 nd4epresentation 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 OBTAINFINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Cont actor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA St- L V� Ljg STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrum�r�t was acknowledged before me The for Ring instrument was acknowledge. before me
this--1 day of ,y\�� 20 `l c�y this day of Lr O Ll/� 20�by
Name of person making statement. Name of person making statement. c
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L L Produced �L
(Signature of Notary Publi p„q orid@IILEN VA ignature of No TM UG HN
WState of Florida Notary Publ c JPpry
Commission No. '; sion # GG 27007 State of Florid _o-` ry Public
q eo C y� mmission Expires mmission No. _* *= mission 4 70079
'�/SOF FSO\ pctober 22, 2022 ;�. oe;' My Commission Expires
°Oii"`` O.tobar 22, 9Q ,3
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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