HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: Permit Number:v,-� "f��
[it�rBuilding Permit Application JUN oPlanning and Development Servicesf,^^ I^ i r l Building and Code Regulation Division Commercial Reside
2300 Virginia Avenue,Fort Pierce FL 34982 -
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: �� Y
PropertyTax ID#: L�� D -� '7_ CZE G/ Lot No.
Site Plan Name: Block No.
Project Name:
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New electrical Meter 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 /RoofPitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Q f? o D Utilities: —Sewer _Septic Building Height:
[� '�"d - 1 r 1
LESs $ q ,y ¢ yl� "�r atm T }� 11TH'. R+ `r rm e�".. "•' .3'�
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Name i / G!'7 Name:
Address: 0 CC Company:
City: /t%c State:z4- Address:-,
Zip Code Fax: City: State:
Phone No._ 6 F6 VS Zip Code: Fax:V
E-Mail: TjEfCl C Phone No
Fill.in fee simple Title Holder on next age (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: T 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 thepermit 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 withyouur 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.
tgnature of Owner/Lessee/Contractor as Agent for owner Signature of Contractor/License Holder .
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before,me of
Physical Pres a or Online Notarization Physical Presence.or Online Notarization
this�day of 20_ by, this day of 20_ by
J
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 �, ,j C , Produced
AAIA
(Signature o No a Pu lic-State of Flori ). (Signature of Notary Public-State of Florida)
AUDREY
Commission No. B($IWPHREY Commission No. (Seal)
a ;*_ OMMISSION#GG 300817
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EXPIRES:Polar
oned Thru Notary public nderwrilers
REVIEWS FRONT SOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.