HomeMy WebLinkAboutBuilding permit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater �n-G` SCJ Permit Number:
SM. LUC E
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
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PERMIT APPLICATION FOR:
PROPOSED- IMPROVEMENT LOCATION:
Address: O 14 0-l'Kb I
Property Tax ID#: L j (`� O — (n�J� ��I r O "� 1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
11 ion d
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing (� _f Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: �I.JQ�O i f� Sq. Ft. of First Floor:
0
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESS'.EECONTRACTOR:
NameI Name:
Address:` G N k{O-4n Company:
City:f%y+ P I State:Fl✓ Address:
Zip Code: Fax: City: State:
Phone No.-11�J-p� Zip Code: Fax:
E-Mail: 1 . Phone No
Fill in fee simple Title Holder on rQxt 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.
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 Appiica6" -
Name: Name:
Address: Address:
City: State: City: State-
Zip: Phone Zip: Phone-
FEE SIMPLE TITLE HOLDER: Not Applicable . BANDING 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 ceiti,ry that no-work•or installation-has commenced priorto the issuance.of a permit ({
'St.Lucie Courts makes no representation that is.granting a Permit will authorize the penmrt holder to build the subject structure
which is in conflict with any applicable Home Owners Assocratron rotes,bylaws or and covenants that may restrict or prohibit such
structure.Please consultwrth.your Home Owners Association and review your deed for any restrictions which may apply.-
In
pply.In consideration of the granting of this requested permit,i do hereby agree that I will,in all respects,perform the work
in accgrdance 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.accessary uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice Pf Commencement may result.in,paying twice for
lmprovementsto your property.A•Notice of Commencement must.be recorded..!'n the public records of St..
Lucie County and posted on the jobsite.before the first inspection.'Ifyou intend.to obtain financing,;cI.onsult
with lender or an attorney beforrp commencing work or recordin gyppr Notice of Commencement. i,
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Signa re of Owner/Lessee/Contractor Ag n for Owner Signature of Contractor/License Holder
STATE OF FLORIDA. 1 STATE OF FLORIDA
COUNTY OF � C"OUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
hysical Presence or Online Notarimition, Physical Presence or Online Notarization
this day of Z .20- by this day of .20 _ by
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
Produced1 CEX, Produced
{Signature of No ary $ e of Florida}. {Signature of Notary Public-State of Florida)
`�tipPY P�4
Commission No. ;:° °4r, E L L �V�C H N Commission No. (Seal)
Ye of F rF a-Notary Pubtic
°' v Commission #
p oma. GG 270079
-:�oR 4�. M Co
Gotot9Or 2 ,'.2022
REVIEWS FRONTR. PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE I
COMPLETED
ev. i.