HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED
Date: _ ` • Permit.Number:.._ . a . _ 7
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-.17 AUG : 2020
Building Permit Applicati;on
Planning and Development Services
Building and Code Regulation Division Commercial Residentlal " - -
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772j 462-1578
PERMIT APPLICATION FOR:
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Address: 31 )0 n/4/7 dP R I2us • A V----
Property Tax ID#: 22 -'2-3 O o d Q 3 0 C)C2 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:$ Too - 00 Utilities: _Sewer _Septic Building Height:
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Name G2 ► �{ ct Name:
Address: �Y 3/y 4 1)dl-e -CV3 Company:
City: FT; State:fz Address:
Zi J
p Code: ��{j �/ SIS� Fax: City: State:
Phone No. `7 a— ;Z o /--? 01!3 Zip Code: Fax:
E-Mail: 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 Applicable
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.
[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'Associat"ion 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 fullconcurrency 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 Reco=d.a Notice of Commencement may resultin,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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA t 1 _ STATE OF FLORIDA
COUNTY OF COUNTY OF
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Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
LlPhysical Presence or Online Notarization. Physical Presence or Online Notarization
This-91i d'ay of 2Q,.� by this day of .20_ by
IJ�6i:17na1 � csS
Name of person making statement. Name of person making statement.
1
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ldentific4tioin Type of Identification
Produc d C_ Produced
(Signature of N j yi a (Signature of Notary Public-State of Florida)
,. °t�` AUDREY�.HUMP EY
(Seal)Commission N =* _ *= [t�YCOMMISSICt 0817 Commission No. Sea!
''Fo'�FtpQ� EXPIRES:Murch 6,2023
Bonded Thru N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW .' REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.