HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST B )COMPLETED FOR APPLICATION TO BE ACCEPTED (� �w,� 1
Date: --n Permit Number:
01To [LUCDC�
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° Building Permit Application
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
PERMIT APPLICATION FOR:
Address: /S
Property Tax ID #:
Site Plan Name:
Project Name: _
2
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Lot No.
Block No.
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New Electrical Meter Second Electrical Meter ����4N�/�A7"�Lroalcrsn 7
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Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 9'�
Name Jo ff ", o 44 6-,YY?-V (Q
Address: Zjr
City: n /^ State:
Zip Code:.r Fax: _
Phone No. 71-/
E-Mail:--rOIV141 .Qr 0,' /yI
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
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Name:" -
Company:
-, t.
Address:
City: �. n. °> .• .. State:
Zip Code: Fax:
Phone No
E-Mail
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.
'I=JPyP.E(VyyIEN1LCyO" ST0RU3CT O�kEN'��LYA�u1/NO�,
/11TIUi'
NOW,t��:h
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:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inuiLaLeu.
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 restrictorpprhibit such
structure. Please consult with your Home Owners Association and review your deed for any, restrictions which may apply.
pI .
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
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
V _r_ inrL r,r ,-o��rHina ����ir NnticP �f Commencement.
with IenQ ran au.u11UCI VIC I -VI inI w 11
- - -- -
Signa re of Owner essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA j '�
STATE OF FLORIDA
COUNTY OF t`l0irld&I
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
hysical Presence Qr Online Notarization
-this 1,0 day of 2020 by
Physical Presence or Online Notarization
this day of , 2020 by
J�Ayl
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of5N ublj K,lQrbflt 06. /
TRACY 66
(Signature of Notary Public- State,of Florida )
CARVALHO
Commission o. Mr Commission GO Mop? �y�f/p-�
2/2024
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
COUNTER
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DATE
RECEIVED
DATE
COMPLETED
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