HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE1 -'OR APPLICATION TO BE ACCEPTED
Date: \aA \ \ I. ta, Permit Number: \�-\ 1a-da3a.
Building Permit App
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: L
3(3D
Site Plan Name:
Project Name: _
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Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters
_Electric _Plumbing _Sprinklers
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Address:
City: mar (�� 11T nQPCQ q State:
Zip Code: Fax: �f T
Phone N/o. -1 3707 )-l��
E-Mail: h,ou\47r,2-7 j/r 6+w%4i , cD✓^
caf ionDEC 1 1 PD19
ST. Lucie Coun
h', Permitting
Residential
Lot No.
Block No.
Windows/Doors
Generator Roof Pitch'
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic'�"' 'Building Height —-
Fill in fee simple Title Holder on next page ( if different
from -the, Owner listed above)
Name:
Company:
Aaarorr.
City: State:_
Zip Code: Fax:
Phone No
E-Mail
State or County License
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.
j
Mr"d
NGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
7Zip:Phone_
_
Name:
Address:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 these rmit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or ancovenants that may restrict or prohibit such I
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 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, CONSULTS
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat r f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this J'\ day of p�c 20__\!l by
The forgoing instrument was acknowledged before me
this _ day of 20_ by
v�
'sio
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 of Notary
Commission No.
- L MAWEGNENS
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MY COMMISSION N GG 022023
EXPId&41)eember 16,2020
,;%p(l fig:•'- 6ondedThrUN0tery PUbGe Uaderwrlt0M
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
1
DATE
COMPLETED
ev.