HomeMy WebLinkAboutBuilding permit application If
All APPLICABLE
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c")� 41 6 Permit Number: 200 b —012 7
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: 6()2 Tori terOP U� for `jQrCP FL 30
Property Tax I D#: C) 1 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 _Roof Pitch
Total Sq. Ft of Construction: F 7 d Sq. Ft. of First Floor:
Cost of Construction:$ �1 t>bQ Utilities: —Sewer _Septic Building Height:.'
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01lltNERLES5EE C NTRAC�E�R ;
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Name ctSon Name:
Address: 136&'1 -Por prL' 1�t'V Company:."
City:_ For-- � port-P State: F/- Address:
Zip Code: 3 4 5' l Fax: City: State:
Phone No. 07.0 3^ 305Z Zip Code: Fax:
E-Mail: eb Ch � Gd �70 MOL It brrN 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 it 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.
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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 lender or an attorney before commencing work or-recording our Notice of Commencement.
Sign, .e of Owner/L s e/Con ractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF A, COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online No ization Physical Presence or Online Notarization-
this—3-Day of 20 by this day of 20_ by
�Cks Uri, Qo,:AC io
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 Produced
(Signature oo f pif�. (Signature of Notary Public-State of Florida),
Public
E NotarY 79
��YP�ec':State of Florida GG (Seal)
Commissio lam. scion s Commission No.
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REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEATURTLE -MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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