HomeMy WebLinkAboutBuilding Permit Applicationr
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED p�
Date: t Q - 1/ 2,.0�'2 o Permit Number: ® 1 b
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3
Phone: (772) 4624553 Fax: (772)
Building Permit Application
-1578
Commercial
PERMIT APPLICATION FOR:,
i W _FL LL &
Residential
Address: `7kd-7 MivoJin .r KYfl . P1-trc.f�
Property Tax ID #: 111 3 0 1 - (an 0-7 (D QQQ S Lot No. 3
Site Plan Name: L Gy tw o 0—A PBlock No.
Project Name:
New Electrical Meter
Additional work to be performed
_Mechanical _ Ga Tank
lectric umbing
Total Sq. Ft of Construction: _
Cost of Construction: $ 10
cond Electrical'Meter
der this permit— check al7tha pply:
Gas Piping tters �ndo s/Doors . _ Pond
_Sprinklers _Generator oof Pitch
Sq. Ft. of First Floor: *101
Utilities: _ Sewer ZSeptic Building Height:
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I State, Cy A
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simpleFill in fee Holderpage
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from the • ...
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State or M
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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. '
M"
SUPPLEMENTAL CONSTRUCTION LIEN. LAW.INFORMATION. ='
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:3CDG &C%0kfSdA9 A
City: i�.i� 11Q1 S'411 State:
Zip: 1 C7 C') Whone a � �I �l Q `) C C)
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Aplication 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 t1i at 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 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
improvements to your property.!A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the j'obsite before the first inspection. If you intend to obtain financing, consult
with I&K e� or an attornev before comm��l^a-work-or recording vour Notice of Commencement.
as -Agent for Owner
OF FLORIDA
OUNTY OF 0,-e Cz..--f9
Sworn to (or affirmed) and subscribed before me of
'V Physical Presence or Online Notarization
s7L thitday of 0��✓ 202i by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary P MON
Commission No. S + OMM
SON
REVIEWS I FRONT ZONING', I SUPERVISOR
COUNTER REVIEW REVIEW
RECEIVED
DATE
COMPLETED
Si nature f Contractor/License Holder
STATE OF INDIANA
COUNTY OF HAMILTON
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this—
M 1day of (:bCRZEer , 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
" %i
_ (Sig ture of Notary Public- State of Indiana )
Yvonne M.Senesac
Commission No. 0664315
PLANS I VEGETATION
REVIEW REVIEW
Hamilton County, IN
My Commission Expires
SEATURTLE I MANGROVE
REVIEW REVIEW