HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST_ BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date Permit Nu rer 4-G?o ►�-f - _
AUG 020 � l
Building Permit Application
Planning and DevelapmentServices i
Building and Cade Regulation Division Commercial LReSIderitiai-
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)_462-1553 Fax: (772)462-1578 t,"L� r--�3 1 vlze 4074-1,
PERMIT APPLICATION FOR:
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Address: l� Ill 0 �
Property Tax ID#: _ c" y (;110 S-19 Lot No.
Site Plan Name: Block No.
Project Name:
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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/Doo,rs _Pond
Electric PlumbingSprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: Sewer —Septic Building Height:
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Name ba Z- Name:
Address: L= t I(I 02 �L�l Company::-
City: '99b % sll G,yee State:tt_- Address:
Zip Code: Fax: City: State;
Phone Na '2I Zip Cade: Fax:
E-Mail: 1- / r 1� Phone No
Fill in fee simp a Title Holder on ne page (ifi 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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:' Applicable.
Name: Name:
Address: Address:
City: State: City:
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 ishereby made to obtain a permit to do the work and installation as indicated.
(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 -
whfch 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 Nome 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 andaccessory uses to another non-residential use .
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resultin paying twice for
improvements to your`prop'erty.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.
Signature of Owner/L ssee/Contr ctor aVftert for Owner: Signature of Contractor/License Holder .
STATE OF FLORIDA ('� STATE OF FLORIDA
COUNTY OF ed `� -,� �. 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 1! dayof_ Deus• 20.3D by this day of 20_^ by
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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 �4iA- d s Produced
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(Signature of Notary lic-State o€Florida). (Signature of Notary Public-State of Florida}
Commission No. oa""`` �. AUJ§gA.HUMPHREY
* *_ MY CO A ON#GG 303817 Commission No. (Seal}
_QQ EXPIRES:March 6,2023
FUOnCeCinrUNOuVIct)naeiwtiteru
1.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER' REVIEW REVIEW REVIEW REVIEW ` ' ' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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