HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABLE INFO MUST BE COMr� ED FOR APPLICATION TO BE ACCEPTED �_, 10 � I r
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Date: -
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Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division ---
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: &(p73 �i
Property Tax ID I16 o- �i�'���03 �����a Lot No. IQ
Site Plan Name: nh am Sell Block No. Sc{
Project Name: T bZlin_,!5J -yl
TAILED DESCRIPTION'O'FWORK:
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Aki h 5
New Electrical Meter
Second Electrical Meter.
CONSTRUCTI'ON.INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:� T5�
Cost of Construction: $ 9100-
_ Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
. OWNER/LESSEE
„-.
CONTRACTOR
-Name_ J Amice IJ a r.Sevl
Name: V'P,'V e U CcCkALKO icy
Address: (f pvt "c ( [a
Company: Arcs AN
City:1/ �1/0-f Vi ere d: State
Address: 9q I
Zip Code: 314�51 Fax:
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City: 6 In 0A4, .O 6&, h State: I'
Phone No. 5b(' (oaS ' 3Af
Zip Code: 3306c Fax: q5Y-7Q-QC1f C
E-Mail: 6r4,n 'I w h WoV e A -TM. Com
Phone No 900 - a 02(0-(X,0.7'1
Fill in fee simple Title Holder on next page ( if different
E-Mail fi16-rr AJ1 r0 ELMS 0 f .Corn -
from -the -Owner listed above)
State or County License 79a38D
-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 RECORDEDNotice of Commencement is required.
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Not
Name
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cityY..... P - - State:
:
Zip: 33ab5— Phone
FEE SIMPLE TITLEHOLDER: — Not Applicable
.Name:
Address: —
City:
.Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
.Name:
Address:
State:
City:
Zip: Phone,
BONDING COMPANY: Not Applicable
Name:
Address:
city:
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 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 restric Yapply.
rPp yhibit such
structure. Please consult with your Home Owners Association and review your deed for anyrestr"fictions which may a I .
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
with lender or an attorney before -commencing work or recording your -Notice -of Commencement.
.as Agent for Owner
STATE OF FLORHYA
COUNTY OF " -i ' L
Sworn to (or affirmed) and subscribed before me of
" Physical Presence or Online Notarization
this _/ 1 day of .__.__._ _._ r2020 by
��n I ex
Name of.person making statement.
Personally Known '/ OR Produced Identification
Type of Identification
MdJ
e_otElorida __ —
(Signature of No ary t t iU GG 322569
a Expires 05/05/2023
Commission No.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
RECEIVED
COMPLETED
Signature of Contractor/Lice se Holder
STATE OF FLORIDA
COUNTY OF i'Do Ord
Sworn to (or affirmed) and subscribed before me of
✓ Physical Presence of, Online Notarization
this _,&(_ day of �GT , 2020 by
Name of.person making statement.
Personally Known —**' OR Produced Identification
Type of Identification
Preduced
fie State of FIgdda
(Signature of It
tary Pu MIN
e�o Expires 05/05/2023
Commission No. 0�T
S REVIEWOR I REVIEW PLANS I VREV EWON I SEATURTREVIEW RELE
EVEWLE I MANGROVE
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