HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr��
Date: Permit Number: 00�'
Building Permit Application
Planning and Development Services 1
Building and Code Regulation Division Commercial 1 Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: /W ��� �/r AIA
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
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New electrical Meter x Second 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: Sq. Ft. of First Floor:
Cost of Construction:$ :OOC^7 Utilities: _Sewer _Septic Building Height:
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Name ��mT �.�n-�-e-.� rr Name:. lulo. -t*
Address: LK-H N !JA U,&,)C l I Company: LA- t,r �� Z
n -Address:,
.City:: �-�� �j�G�- State:t�
Zip Code:: 3`"I�I Fax: City: "' State:
Phone No.. '12-1 J49 V-7 Zip Code.3 3`1"i`I Fax:
E-Mail: Phone NoC172D `'V6-eX7-Z
Fill in fee simple Title Holder on next page (if different E-Mail GQ��i"•�coo/nom f�''�''
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: Stater
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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signfe w r/Lessee or as Agent for Owner Signature of, thicor/UcVke H der .
STATE.OF FLORID, STATE OF FLORIDA
COUNTY OCOUNTY OF
Sworn p4or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
hysical Presence or Online Notarization cal Presence or Online Notarization
thisday of I'��20�&by this 2q day of ,G+ 20" by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification L� Personally Known OR Produced Identification
Type of Identification Type of Identification
Produ edli Produced )r1,-
Signature of Notary Pu ic-State of Florida) . =�4 0�'� (Signature of Notary Public- ate of Florida) '°
Cn
Commission No. at
(Seal) o d= Commission No. (Seal) -J,-
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REVIEWS FRONT ZONING SU �it PLANS VEGETATION SEA TURTLE ($ '
COUNTER REVIEW TW tZ. W REVIEW REVIEW REVIEW If C
DATE o X d T N a ib,c m
RECEIVED W<O
DATE N map yv°O
COMPLETED V�'
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