HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
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Building Permit Application. Unty
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:.
Property Tax ID#: Q� � ` bCO l -n(3 0 13 Lot No.
Site Plan Name: �,s �,��-a C ro "1. L Block No.
Project Name: mot.rnSuG!-
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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 _RoofPitch
Total'Sq, Ft of Construction: Sq. Ft. of First Floor:
.Cost.of Construction: $ dlf o o, Utilities: _Sewer `Septic Building Height:
p11tfNEEi L 5$EE�' ��� z
Name- s Eke-+'t Cr ( Name:- C.kr,s ,
Address: 2-711 S. Company: Ca .--ke CoA-r-►�� - S
City: p er-t-e_ State: Address:
Zip Code: 3 "2— Fax: City: State:
Phone No. 65)'7- — y3- 7 77 9 Zip Code: Fax:
E-Mail: Ln i d-w 1. Phone No
Fill in fee simple Title Holder on nex 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.
Mill INS=
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not. pplicable
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'holde'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 thatl 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'(Yotice cif Commencement may-result in.paying twice for
improveme.'nts-to your property. A-Notice of Commencement most 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 COMMOneffig work or recording our Notice of Commencement:
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA ` STATE OFTLORIDA
COUNTY OF �� 1 ���� 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 2-0 ` by this day of ,20. by
OYT5 rp -
Name of person making statemen . Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific t�� Type of Identification
Produced Produced
(Signature of Notary Public-State F `' , A GIj
of_Notary'Public-State of Florida)
IS State-ofFlorida-N"toy"Commission # G 27SealCommission No. My Commission � n No. .(Seal)
October 22 022
REVIEWS FRONT ' ZONING SUPERVISOR PLANS VEGETATION SEATURTLE 1MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.