HomeMy WebLinkAboutBuilding Permit Application Ali APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTEDaa�, -���j
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SEP 16 `,u2 0
ST. Lucie County, Permitting
Building Permit Applice
Planning and Development Services
Building and Cade Regulation Division Commercial Residential i/
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLfCATION FOR:
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Address: �J 3 �"�` C, r� . >ri e rC�C 3-�`t q.
PropertyTaxlD#; `baa` O�d" Lot No.
Site Pian Name: Block No. 5 .7
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 Plping `Shutters _Windows/Doors u Pond
Electric y Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: 1532- GA Sq. Ft. of First Floor:
Cost of Construction:$ �, S�� . � Utilities: Sewer _Septic Building Height:
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Name- Neme: ._._..,,_.,..._ ... .. .
Address: cS/Ll ? /�J"c "v e yr- Coiiipany,.
City: �r`a" t`�rc State: G Address: ,ht,
Zip Code: 3ggS 2,_ Fax: City: State:
Phone No. `a - L2/3 _ 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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IGNERjENGiNEER: Not Applicable MORTGAGE COMPANY: Not Applica15-e
me Name:
Address: Address:
City: State: City: ;State: ,,
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ^Not Applicable . BONDING COMPANY: Not Applicable
Name: - Narne:
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 thaf`no work or'{nstallation has commenced par to ttie issuance of'a permit:
St.Lucie County makes no'representation that is gran'ting a permit*wilt autiianze the permit holder to build the°subject structure'
which is in conflict with any applicable Horne Owners'Associatton rules;bylaws or,:and covenants that may restrict or prohibit such
structure.Please consult with'yotir Home Owners'Association and review your-deed for any restrictions which may apply.
In cori,sideration of the granting of this requested permit,!do.hereby agree that�l will,in aIl'respects,,performihe work
in accordance with the approved plans,the Florida Building Codes and'St.Lucie County Amendments.
The fol{awing building permit applications 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 OW ER:;Your.failure to Record a Notice,of,Commencement may result in,paying.twice4or,
improve'nients to your property.A Notice of Cammencemerit must be recorded tn`the.pubfic records of St.;
Lucie County and posted on thejobsite before the.fiest inspeeticin.-If you intend to!obtairi.firiancing;consuit
with lender or an attQrney before.commencing work-pr.recording our Notice of Commencement:'
Signature of ne essee/Contra'ctor as Agent for Owner Signature of Contractor/License.Haider .
STATE OF FLORIDA STATE OF FLORIDA
C.OUNTY•OF Sk, Lyc,'�fi COLINTYOF,OF, .
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and'subscribed before me of
Physical Presgnce or Oniine Notarization Physical.Presence or Online Notarization
thisRs_�d'ay of. t .20ad by this day of ,20 by
Name of person mak!Ag statement. Name of person making statement.
Personally Known OR,Produced Identification Personally.Known - OR Produced Identification
Type'of identification Type of identification,
Produced 1b L Produced
(Signature of Notary Nbli Signature of:Notary Public-State of Florida)
z. D NNAMME GIVENS' itA
Commission No., v`a ;.: ¢YGI$SIBN#GG 022023
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aDeembert6 2U20 �iammission No. (Seal)'.
�h�A11�+°�` Bonded Ttvu Notw y Fubiia UrMBrwntef
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE - MANGROVE
COUNTER REVIEW REVIEW"' REVIEW REVIEW 'REVIEW- REVIEW'
DATE.
.RECEIVED
DATE
COMPLETED
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