HomeMy WebLinkAboutBuilding Permit ApplicationAIS APPLIC BLE INFO. MUST 8E COMPLETES? SUR APPLICATION TO BE ACCEPTED
Date Permit Number.
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LLS;
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*t Application
Bu*ild-ing Perini
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PJarrning and Development Services
Suildin and Code �e ukr�ion Divi
9 9 11
Sion Commercial � Residential
.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:01�
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit -check all that apply:
V'oMechanical � Gas Tank � Gas Piping . ^ Shutters Windows/Doors Pond
Electri-c � Plumbing � � Sprinklers � Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of first Floor:
Cost of Construction:
$ q, 2(m � Utilities: Sewer Septic Building Height:
Nam � r � i
CA � ,_.............._..�..�.... Name : �
Addres.s.- - is �Avd Compan
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city: _Stater Address:- Ll Sl(o S"V C - -e4
Zip Code: � � � ��.. Fax City: �� �-�- „ .„,..,,,,.,,...,......�... Stater
Phone Zip Code: 4 q Fax:
E -Mail: A -Phone No "M) r('��
Nil in dee simple Title Holder on next page if different E --Maid "Vru�.4 LLQ � �,`,'� � Co rv-% .�
from the owner listed above) State or County License (:�. R A P I I 6�
If vafue of construction 'I's 2500 or moreF a RECORDED Notice of Commencement is required,,
If value of HAVC i $7,500 or more, a RECORDED Notice of Commencement i . req u i red.
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DESIG-NER/ENGINEER:
Name:
Address:.
City: S
Zi : Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
ky State
Zi'p: Phone:
BONDING COMPANY: Not Applicable
Name:
Address.
City:
ZPhone:
OWNER/ CONTRACTOR AFFIDVIT:-Application is hereb-y made to obtain a hermit to da the w�r�C and installation as indicated.
certify that n work or installation has commenced prior to the issuance of a permit.
St. i.ucie Countymakes n representatiar� that is granting a permit will authvrize the permit hollder to build tF�e subject structure
whichis in conflict with any applicable Home Owners Association rues, 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 applicatians are exempt from undergoing a full concurrency review : roam additions,
accessory structures, swimming pools, fences, walls, signs, screen roams and accessary uses to another non-residential use
WAR -NI -NG TO OWNER: Your failure to Record a 'Notice of Commencement may result *In paying twice for
improvements to your property. A Notice of Commencement mush be recorded in the public records of St.
Lucie Coun,�y and posted an the jobsite before the first inspection. If you' intend to obtain' financing', consult
with I end�F off- an attorney before cammen cinp, work or record ine vourNatice of Commencement.
FA
Sigr�ature o�F�iiiner/,�essee/Contractor as -Agent for Owner-< � Signature v ract
SPATE OF FLORI
COUNTY OF
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to (or affirmed and subscribed before me of .
sisal Presen r On-line Notarization
day of , Zazv by
Name of person making stateNnenf
Personally Known _ DR Produced Identifcatiofi
Type of Identification
Produced
in
Commission Flo.
icense Holder
STATE OF'FLORIDX..%
COUNTY OF ll`
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this
odor affirmedj,ar�d subscribed before me of
sisal Prese r,.e or Online Notarization
day of . 2020 by
Name of person making state
ht.
Personally Known OR Produced #dentifica
Type of Identification
Produced �1
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LAVILP U61 i Q� orj%�H
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� o ar}r u -1 c - State of Florida D ry � � �� � _ . Pb blic - State of Florida
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Commission � GG i 35939 • %: •G�, 135939
=� ;.` �41I Co�t�E!i�eS5ep29,2a21 Commissit�r� No. ^''�� ���` MY�&�res5e Y �. oQ;••' � P ��� 2021
6nntiedt�sraughlvaticrai�IctaryAssn , •,����' 6a�de thr�ugi�NatianalNotaryRssrt. �j
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE"
COUNTER REVIEW R EVI EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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