HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:!'` '°Z� Permit Number:
G RECEIVED
Building Permit Application or.T 3 0 2020
Planning and Development Services
An'tcle
g Department
Building and Code Regulation Division Commercial Residential County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772),462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: 5 L7 5-- Oct Iwo
Property Tax ID#: �yoa'G �a'dy'19- �aOJ \ Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit-check all that apply:
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_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: $ a 06� Utilities: —Sewer _Septic Building Height:
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Name To6n MQC�i(20 Name:_W12 eo'
Address: Company:
City: o r-� P-,if CC p• State:., Address:
Zip Code: �'- YR8 Fax: /I/dA.le City: State:
Phone No._ 7 `77 - 3,5:7- 7t-5'/7r Zip Code: Fax:
E-Mail: /Inli1 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: c Name:
Address:Sao fM Address:
City:-Fa C} `e I-C e State:?� City: State:
Q
Zip: ��. Phone I 7 5''7/ Zip: Phone:
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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 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
structure. conflict
leasie consult with your Home Owners Association Association rules,
your deed for any restrict that
which maor
a prohibit such
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 our Notice of Commencement.
n ure of Owner/Lessee/ rac as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA n STATE OF FLORIDA
COUNTY OF �T L�l)C °v �Gt)11 -� COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
X Physical Presence or Online Notarization Physical Presence or Online Notarization
th ''a day of 02020 by this day of 2020 by
This
5 e-lti V_% Irv,a i Z g
N Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced
�. Produced
Prod
(Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. <v D0611SION#PAIE HENS (Seal)
MYCOMMI SION#tGG�-2023 Commission No.
beef 16"2020
it � EXp1REV.Dece ndenadteT5
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REVIEWS FRO
�' ''� SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COLIN R REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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