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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: {4.. ® lamF ' \ Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential Z- / 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772)462-1578 i PERMIT APPLICATION FOR: c Chi, y eV e)U IT FiidP©SED iP1�0\!' l�li �1T L�f�ATiCJ�1i �� Address: 10200 S , OCeo" -bY , u -r /d :?- Property Tax lD#: cs �� � ✓` l ZS ��©5 ��� `� Lot No. Site Plan Name: t(S y Block No. Project Name: I TA1C31aCRIPTt{ �b, 4t011 , �df „„ New Electrical Meter Second Electrical Meter r `t kA Additional work to be performed under this permit—check all that apply: 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: ost of Construction: $ —3 Utilities: _Sewer _Septic Building Height: { I / 51 sQNTRAt tR ��.. . ,� „a�£;S�Z ,,_, .:. ., �M C� Name }� 11 Q ler Name: C pS I C� Address: / Z S ' W+r� V i� Company: D�[�(I/1/ Cd I �� VIJC City: -E�; T State: Address: �� I < P41 0061rT_ CT. Zip Code: -3 Fax: City: Stater I_ Phone No. Zip Code: �� Fax: ' E-Mail: Phone No �2 7 Z Z Q 3 Fill in fee simple Title Holder on next page(if different E-Mail (vvCO 0 11 j from the Owner listed above) State or County License 16 ZO4" If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. i If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. ILL— i SUS'RLE�/IEf �'�L}�Q1STRUCT1t�N:LIED�LA1t4l'1NC�FtN1�TI�C}> , r 3 y y � g 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: 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 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 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. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF PA-9- COUNTY OF Sk, Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of Ph sical Presenc or Online Notarization Physical Presen a or Online Notarization this day of AbV 2020 by this L day of W 2020 by Name of person making statePneirit. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Prod ed Pr uced *A1 Cc)ku'o (Si at re of Notary Public-S to of Florida) (Signature of Notary Pub' -State of Flor a ) Commission No. (Seal) Commission No. (Seal) I i i REVIEWS FRONT T ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED rev.