HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
TO, BE ACCEP
RECEIVED
NOV 2 5 1020
' Permitting /Cnty
nt
St. Luci
ential
PERMIT APPLICATION FOR: (�� �� U k T- e � I
Address: k `016T—s —4::S- 0 cteo\ ` fir. L16av-Ali,��
Property Tax ID #: �� ' �� Imo%, '�� Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply: Y
_Mechanical _ Gas Tank —Gas Piping _ Shutters s/Doors _ Pond
T Electric _ Plumbing _ Sprinklers _ Gener _ Roof Pitch
4 Q
Total S . Ft of Construction: S . Ft. of Firstor:
test Of C'd�'S# "c RniJ Utilities: —Sewer —Septic Building Height:
Name c
Name: —
Address: °
Company:
City: T6,5'F ,A.= State:-'EI..—
Address:
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Zip Code: -Fax.
CityX,
Stater
Phone No. _ o�`t �—
Zip Code: --73 Fax:
E-Mail:1\ 5� i, -' C-406k
Phone No2,LU—
Fill In fee simple Title Holder on next page ( If different
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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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SU.PPLEMEN� �AL�CONSTRUCT ONp�LIEN. 1N III
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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 attornav-before commencine work or recordine vour Notice of Commencement.
ignature of Owner/ Lessee/ ontractor as Ag i t for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA _
STATE OF FLORIDA
COUNTY OF Ll �. �.I; _
COUNTY OF
Sw,�Fn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and sub ore me of
Physical Prese a or Online Notarization
Physical Presence or a Notarization
this day of 2020 by
this day of 2020 by
M'R Zk. l= (-A) 2L- I \
,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identific n
Type of Identification
Produced \ L..
Produced
(Signature of N
X�ia"
(Signature of Notary Public- State of Florida )
Commission N
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Commission No. (Seal)
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Kev. 5/b/zu