HomeMy WebLinkAboutBuilding Permit Application L4>- L 7LO
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Numb r:
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K/IAY 2 202.0
Building Permit Applicati n i
Planning and Development Services e r ""` :,1 c`'I e q t
Building and code Regulation Division Commercial Residential=a_!`
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: CC 2_
PropertyTaxlD#: �� 1 �d� �Vr Lot No.
Site Plan Name: Block No.
Project Name:
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New electrical Meter Tl, Fecond Electrical Meter
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank Gas Piping Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers —Generator —Roof- Pitch
Total Sq. Ft of Construction: 4:9W. Sq. Ft.of First Floor:
Cost of Construction:$ � �^CI�`�� Utilities: _Sewer _Septic Building Height:
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QItERISS�� Y
Name c e-, Name:
Address: 3-7-3 Z .5 E S-rd Z30 S7 L?J Company-.:..
City: T�A2.t FL_ State:_ Address:
Zip Code: -3+Cty7 Fax: City: State:
Phone No. `7 72-5 t cr - 3 6,76, O 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 HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
.
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 paying twice for
improvements to your property:A Notice of Commencement must be recorded.in the public records of St._
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I der or an attorney before commencing work or recording our Notice.of Commencement'.
Signature of Own ssee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA )) STATE OF FLORIDA
COUNTY OF �7 J GL C/ Pi COUNTY OF
Swto(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Ph 'cal Presence or Online Notarization Physical Presence or Online Notarization
this day of j122 4D.'�J2000 by 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
Produced C1 r, 2 L• Produced
(Signature of Nota ublic-State of Florida). (Signature of Notary Public-State of Florida)
Commission No. ;a�• R�. AUDR"HgMPHREY Commission No. (Seal)
COMMISSION#GG 300817
r,.• r,� EXPIRES:March 6,2023
;.
one hru Notary Pu lie Undenxrltors
REVIEWS FRONT TOM R PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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