HomeMy WebLinkAboutBuilding Permit Application AIII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED
Date: 1� ) Permit Number: OU
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: (772f 462-1518
PERMIT APPLICATION FOR:
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Address: S+9LA Se 6e_S4WQ 0,L
Property Tax ID#: 6I I AtJ'l 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/Doors —Pond
Electric _Plumbing _Sprinklers _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 Name:
Address: L- fe v Company-
City: `O State:f�L Address:
Zip Code: 3 41 Fax: City: State:
Phone No. L — Zip Code: Fax:
E-Mail: 2 7i, 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.
DESIGNER/ENGINEER: _Not Applicable . MORTGAGE COMPANY: Not ApplicaEile
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 dothe work and installation as'ind Gated.'
f certify that'no workoriristallation has commenced prior to.the•issuance ofa permit:
St.Lucie Counttyy makes no representation that is granting a permit will authorize the' ermit'holder to build'the subject structure;
which is in.conflict•with any applicable Home Owners Association rules,bylaws or and covenants.that.rnay 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,.1 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 failureto Record a Notice of Commencement may result i-n.paying-twice-for-
improvements`to:your property:A-N'otice of Commencement must`be-recorded.,in the.public 'records of St..
Lucie County"and po ed on a jobsite.before the fiest'inspection: If you intend to,obtain financing,.consult
With-lender-de an-a. One of re_commenCi❑ -Work orrecordin our'-Notice' of Commencement. ,
Signature of Ow essee/Contractor as Agent for Owner Signature of contractor/License Holder .
STATE,OF FLO IDA f _ STATE OF FLORIDA
COUNTY-'OF .��CIP COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Not ation Physical Presence.or Online.Notarization-
this day of �Dl
y this day of 20 by
V.
tdo
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_ o—`i� -- -Produced 4"
(Signature of.Notary P c- at o a). (Signature of Notary Public-State of.Florida,)
Commission No. Commission No. (Seal).
Ny'eloN e yo/ss o
ljf
REVIEWS FRONT ZONIN UP „ PLANS' VEGETATION._` SEA TURTLE, MANGROVE
S.
COUNTER REVIEW p,�,°?` EVIEW REVIEW REVIEW 'REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.