HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l'dy'vry• Permit Number:-
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Building Permit Application
Planning and Development Services Pe i f-n I
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Building,andCode Regulation Division Commercial Resfdd tial e
2300 Virginia Avenue,Fort Pierce FL 34982 -- -
Phone: (772)462-1553 Fax: (772)462-1578
1
PERMIT APPLICATION FOR: �1 ot b.
PROP®SEDIMPROVEMENTLOCATION
Address: 3—a 3 S' 0,4WI 4r✓I, .<"We CIR tCO97'
PropertyiTax,ID#: l Lot No.
Site PlanlName: Block No.
Project Name:
dDETAILED-DESCRIPTION'OF WORK
�.✓c/�ETE Citi/0 SLA 3 X
dl u4ur—p_ �r o.cit v M 4 )1 )9 Ve 4
New Elei trical Meer Second Electrical Meter
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�CONSTRUCTI'ON INFORIVIATION
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: ZAD 7C77— Sq. Ft. of First Floor:��,� S� 177—
Cost
TCost of Construction:$ ���Q, Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
"CONTRACTOR:,
Name c/6-. I) `
Address: ,��3�� Ofi`/� /✓� l✓Q" E''C/�' Company
City:Fa,R r l E,2cc
State.:jL Address,:
Zip Code: .���J`-/ Fax: ;. City: ',;: :,::". ; ;;. : State:
Phone No. D� `� 3 —41 9..5 Zip Coder Fax:
E-Mail: ?AOt5 - i9i✓37-6G11o7r^41Z • Com 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 is 2500 or more,a RECORDED Notice of Commencement is required.
f value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENLIE
ENTAL CONSTRUCTION N LAIN INFORMATION
E. . . .S. - - .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable z
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 th t'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.
Signatu of Owner/Lessee/Con actor as Agent for Owner Signatur of Contractor/License Holder
ST E OF FLORIDA STATE OF FLORIDA
COUNTY OF 9• luc,-L COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
VPhysical Presence or Online Notarization Physical Presence or Online Notarization
this 2-0 day of�J�AT ,2020 by this day of 2020 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
Produced LLaja&
Produced
(Signature of Notary Piu lic-State 0Htur of Notary Public-State of FloridaKARALEIG )
;.��nr�•.,s {SSIOfI Go 269704 t
Commission No.C�G2locl—DL,_ a• AA1fC M
m , � ^--p(,PIRES:Fe �tssi No. (Seal)
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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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