HomeMy WebLinkAboutBuilding Permit Application All APPLICABL IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3� ��� Permit Number: "90
0209
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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:
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Address:
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Property Tax ID#: I 130i `46l - 00-L 1 6007 {y�� Lot No.
Site Plan Name: d i e C,C'� .l.J Q I"m-c /c-�/ Block No. �
Project Name: w cJ A L G6
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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/Door's _Pond
j_Electric _Plumbing _Sprinklers _Generator A_Roof 'Pitch`.
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Total Sq. Ft of Construction: /��oC) Sq. Ft. of First Floor: �6Od
Cost of Construction:$ �!®�� Utilities: —Sewer ,Septic Building Height:
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Name rVl j I Name: ;
Company:
City: l-t, PiGP State: Address:
Zip Code: 3l 957 Fax: City:. State:
(hone No. 7 72 - Ce If ZWY Zip Code: Fax:
E-Mail: G r 9 efo+- ad Lem 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.
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 COMPA _Not Applicable
Address: Address: 2�01 W�115 �r o
City: State: City: ;n a .'State:
Zip: Phone Zip: S590 _T000 Phone:_ -goo - R'(n - SS-5 7 —
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 y and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wit ende or an attorney beforejeommencing work or recording our Notice of Commencement.
ig re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,�� , COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 2040 by this day of ZO_ by
Name f 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
(Si at a of Notary Public-Slate of Flom (Signature of Notary Public-State of Florida)
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Commission No. :_ ��: �p }
ff .ommiSSI+Jh1X275069 Commission No. (Seal)
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EXPIRES:December�0,,_0.:
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW- REVIEW REVIEW REVIEW
DATE .
RECEIVED
DATE
COMPLETED
ev.