HomeMy WebLinkAboutBuilding Permit Application All,APPLICABLE INFO MUST BE COMPLETED FOKAPPLICATION TO.-BE ACCEPTED
Date:' Permit.Number:
5
z AUG 2020 �
Building Permit Application !
Planning and'Development Services
Building.and Cade Regulation Division Commercial
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: t 1 1,4 7 Walz z— YI/ �U ✓
Property Tax ID#: ('D r CO Z ` �O� Z_ Lot No. 6.a
Site Pian Name: Block No. /11
Project Name:
New electrical Meter 1 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: /0670 Sq. Ft. of First Floor:
Cast of Construction:$ �" Utilities: _Sewer Septic Building Height:
_ v�. A '! � .1 •. W � 3 4 $� ;�.�^"x..._aLkL,rt•SSC:?1V,ivmv.lZu.
Name r� IGoAl#'% Name:
Address:) �'d 7 o U)14Z,7-0A1 A-y-e Company:
City: State:�C. Address:
Zip Code: / Fax: City: State:
Phone No. 7 V7 A 7 6 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.
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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.
I`certify.that no work or-installation has.commenced.pridrto the issuance.of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holderto 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 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 Notice of Commencement may result,in,paying.twice for
improverrients to your property. A-Notice of Come
mncement must b'e-eecorded:.inthe publ e.records of St..
Lucie County and posted on the jobs to before the first inspection. If jyou�intend to obtain financing, consult
with lender or an attorne .before commenci 'ork or_recording our Notice of Commencement.
I
SigtytureofOwner/Lessee/Contractor as AA4t for Owner Signature of Contractor/License Holder .
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF COUNTY OF • -
Swoopi.ta(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Oniine Notarization Physical Presence or Online Notarization
This day of .20;2, by this day of .20 by
d 14 Al, 144 A Z±01Vr,-v
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ` Personally Known OR Produced Identification
Type of Identification ,...,// f Type of Identification
Produced l�l I C ' Produced
(Signature of NPu ' - __. _ (Signature of Notary Public-State of Florida)
?C<A VPug'{y�', AUDREY B.i iUMPHREY
Commission No. QQMM15�' l}3 7300817 Commission No. (Seal)
s
EXPIRES:March 8,2023 �
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REViEW.
DATE
RECEIVED
DATE
COMPLETED
Rev.