HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED m
Date: ��`�t® Permit Number: f/f�� + D3�
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Building PermitkApplicaltion
Planning and, Development Services
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Building and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL34982 i �,i � E)epartment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residentiaht-Ja County, FL
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Property Tax I D #:
Site Plan Name: _
Project Name:
I° DETAILED DESCRIPTION OF WORK:
ICONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
Electric _ Plumbing —Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:$ 3000
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER LESSEE:
_CONTRACTOR:
Name Gqraga
Name: till #J
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Company:
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A n tic*i State:'_
city: %K4z-
Zip Code: rc� _7 Fax:
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Address:
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City: �2�l
Zip Code: "6 LI016 -7
Phone No '"a -�b70
State:
Fax:
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail CA, OV Lm
MOWMIVIOME
State or County Limense3ld
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1011371 qY11110-11,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required..
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Address: I Address:
City: State: I City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
Zip: Phone: I Zip:
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 apprpved 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 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 INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N0710E OF COMMENCEMENT."
Signature of Own r/ essee/Contractor as Ag nt for Owner
Signature of Contractor License Holder
STATE OF FLORI
STATE OF FLORI jI
COUNTY OF 1,�A r i e.
COUNTY OF T'• �,1, ue.)
The f going inst ent was acknowledge before me
The f going inst ent w s acknowledged efore me
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Name of person making statement.
Name of person making ment.
Personally Known OR Prgduced Identification
Personally Known OR Produced Identification
Type of Identification -_• 7W
Type of Identification
Produced b '3�Q
Produced
Si a[ure of Notary Public- Sta
re of Notary PuISEATURTLE
COmm1551on��+ r� r� ' t A����rrr���,,,�"" Notary Publie State of Pori
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te of Florida
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See3)le Baird
My Commission GG 2a1
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12105/2022
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VEGETATIOGROVECOUNTER
REVIEW
REVIEW
REVIEW
REVIEWIEW
DATE
RECEIVED
DATE
COMPLETED
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