HomeMy WebLinkAboutBuilding Permit ApplicationFOR APPLICATION TO BE
All APPLICABLE INFO MUST BE
Date: S �Lc - aA
ST. OULUNT
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Planning and Development Services
REcEtveo
JUN 0 4 �n'n
Building Permit Application P s Qonpanm,
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Building andCodenegulationDivision Commercial Rncirlantial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
',F�RgPaSI= �1, ��tO�/EI�l1Et�T�lOCAT�ION..
Address: Jr q 0 -3 rc-\ `7 r-•
Property Tax ID #: 3 Li 2- 6 0 9 - 0 3 82 - 0 O d - 25' Lot No.�_
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter.
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
_ Gas Tank
—Plumbing
Total Sq. Ft of Construction:
q o0
Cost of Construction: $ I�iD
—Gas Piping
_Sprinklers
_ Shutters
Generator
✓ indow /Dc)�rs
Roof
Sq. Ft. of First Floor:
Block No. Ca
_ Pond
Utilities: _Sewer _Septic Building Height:
Pitch
�QWlVE��,(♦LE5SEE:
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Name � ✓1 (
Name:
Address: 5 `Z
Company:
Address:
City: 102 t Qr'Z�e -:�L. State:
Zip Code: ' 3 y 9 g Z Fax:
City: State:_
Phone No. 33 z- -�g. ° q I
Zip Code: Fax:
Phone No
E-Mail:V\�A�Y @. ��So4�L.(let
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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name: Qy %cA4ewn I.t oy1S
Address: Address: /a 5 <6 Moo cwa A✓c
City: State: City: 172�rd ; k State: �t (/ 7;C
Zip: Phone Zip: gXAP(p Phone: RQO- 50�?- 09Yy
FEE SIMPLE TITLE HOLDER: 7& Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Address:
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.
no representation that is granting a permit will authorize the permit holder to build the subject structure
any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
It 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 1 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 FALLURE 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 YYTEND TO OBTAIN FBIIANCING, CONSULT
TMM YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.'
r
as Agent for Owner I Signature of Contractor/Ucense Holder
STATE OF FLORIDA - / STATE OF FLORIDA
COUNTY OF Sle 1 & a> COUNTY OF
The forgoing instrument was acknowledged before me
this 2L day of 20-2.aby
C«I �eJ 2c�a
Name of Orson making statement.
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement
F(. �.L Personal) Known OR Produced Identification
Personally Known Y
Type of ldentificats +�° "0r Notary Public—State,6fZO:z Type of Identification
ProQduced =• Commissions Produced
C/. I_Lmrrl.en. 2. d`.= Comm upm Sep 24,2021
(Signature of Notary Public -State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER I REVIEW I REVIEW I REVIEW I REVIEW I REVIEW REVIEW
RECEIVED