HomeMy WebLinkAboutBuilding Permit Application 1 ,
All APPLICABLE INFO MUST BE COIMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 6 2�5�-e� Permit Number:
I [LUCDIS
�WsBuilding Permit Application
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Planning and Development Services)
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
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PERMIT APPLICATION FOR:
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PROPOSED;IMPROVEMENTLOCATION: `
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Address: � E Lar !o f V EEOS
Property Tax ID#: �D�006VO 5 7� Lot No.
Site Plan Name: ! Block No.
Project Name:
� I DETAILED DESCRIPTION OFWORK: . _
��L /de-1
New Electrical Meter ! Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
4EIectric _Plumbing/ _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 0 L-r`�" Sq. Ft. of First Floor: yf )s-P
Cost of Construction:$ 1.+ (� Utilities: X Sewer —Septic Building Height:
OWN E R/LESSEE-,
CONTRACTOR- '
Name Name: 6a- .
Address , Lcs , Company: t� n<� MM1.o 37 i Ivy
City: err J(--S 7-Llcca_. ��jj State: Addresls: .3 I� v�5
:Zip Code: Fax: WAr City: YC'� 7— 5�-/���_'� State: C�
Phone No. Zip Code: Fax:
E-Mail: /'wlf(-14 7?34 -0eQGoie-,f4,/UC+ Phone No 27 y.'Z
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Fill in fee simple Title Holder on next page(if different E-Mail l �C1 -6 DCbm nAS'�-' A cf
from the Owner listed above) State or County Licens OQ C I 51AS 71
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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Sll'PPLEIVIEN:TAL CONSTRUCTION LIEN I AW, _NFORMATI.ON:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: yrNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: j_Not Applicable BONDING COMPANY: Not Applicable
Name: I Name:
Address: Address:
City: I 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 6ccordance 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 all.orney before commencing work or recording our Not' a of Commencement.
Signa' e of er/Lessee/Contractor as Agent for Owner Si Pure of tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF oStie.r, COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pres ce or Online Notarization Physical Presence or Online Notarization
,this�day of 2020 by thisa\ 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
P oduced Pro uced
ignature of Notary Pub_' -State of Flori (Signature of Notary PubliL4.State of Flo a)
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Commission No. .PU HNAING Commission oo. ING S
�`'` �: HMING RAM. I A
*; *; MY COMMISSION#GG 275060 -* °*, MYCOMMISSION#GG 275060 !`
:^s ecem er 2 U,Nil ecem er 20,2W 2s:
REVIEWS ` Bond d Flu 3_ ISOR PLANS ded h 1�I �� � N G R 0 V E
NTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.5/6/20
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