HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE %;LiMPLETED FOR APPLICATION TO BE ACCEr i ciJ
Date: Permit Number: 1 IOL—
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-----� - -- Building Permit Application
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Planning and Development Services
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Building and Code Regulation Division
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: D` l4 I&Lje&Z,
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Property Tax ID #: Po l Wa'' 0
Lot No. _
Site Plan Name:
Block No.
Project Name: (34 40
E i ETA 121 E W DESCRIPTION F WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters —Windows/Doors
Electric _Plumbing _Sprinklers _Generator —xRoof
Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer Septic Building
Height: /D
OWN@R LESSEE: CONTRACTOR;
Name i Name:
Address: O Company:
City: U StateFL Address:
Zip Code: .3�t�� ( Fax: City: Iaiar•.tr: :- !isasi; :w x:.;,
State:_
Phone No. �u•t:iuice:.:..:aw
S'/3—SoL0-6-L04i Zip Code,': ��.nc-;•-„r,. _n.�,,-,.Eex
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E-Mail:e?016,91,G4 X: ,TW i B/J H•A1
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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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:
Si4 Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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." -
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA.
COUNTY OF
COUNTY OF
The forgoing instr ent was acknowledged before me
The forgoing instrument was acknowledged before me
thiQn day of R l �, 20\1� by
\ �A(%IQ°r
this _ day of 20_ 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
Pro�ducceed(�
Produced
(Signs ure of Notary Public- ate of Florida)
(Signature of Notary Public- State of Florida )
Commission N
Commission No. (Seal)
:'!"�RAM MING
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RES. Dacember20,2022
REVIEWS
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VISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
R VIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/1.9