HomeMy WebLinkAboutBuilding Permit Application AII'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9[LUME
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential _
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: S
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Address: �S C & A 'UJQ��n N rcu1 9;Ia]CQ �l q Z
Property Tax ID#: � 9()Z-00 1_7—Q0rQ:() 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:
- _Mechanical _Gas Tank _Gas Piping _Shutters _Winddvvs/Doors _`Pond
_Electric _Plumbing Sprinklers _Generator -Roof' Pitch
Total Sq. Ft of Construction: Sq.,Ft. of First Floor:
Cost of Construction:$ LF, roo Utilities: —Sewer —Septic Building Height:
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Name ')Mrl Name:
Address: 3 Company:
City:-_Foci P;-eCCQ State: Address:.
Zip Code: Fax: City: State:
Phone No. `77?_-167- US2 Zip Code: Fax:
E-Mail: vmftl Phone No
Fill in fee simple Title Holder o 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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,UF�PLEMEN ALCON�TR, ��T� �� �NL�A'WN'30 .• M�". ,r � .P.3; •.' � .,��.,
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 Msociation•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/Con acto as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID , STATE OF FLORIDA
COUNTY C ,ra COUNTY OF
Smv to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical PreserMe or Online Notarization Physical Presence or Online Notarization
this J'J day of Qag_ 2020 by this day of 2020 by
Name of person making stateme . Name of person making statement.
Personally Known OR Produced Identification+ Personally Known OR Produced Identification
Type of Ide4Uificatiion Type of Identification
r duced Produced
(Sig Ature of Notar, :*7p -?'
`eta M BANNING (Signature of Notary Public-State of Florida)
*; Y COMMISSION#GG
Commission No. o� pIRES: 275060 Commission No. (Seal)
ed Thru N er20,2022
Lary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA-TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20