HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: pCof L' •�(oiQlS
'DECEIVED
�4o dC�COL -
G NOV 17 2020
'Building Permit Application Permitting DQpartrner
Planning and Development Services St. Lucie County
/
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:
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Address: 5
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Property Tax ID #: 340Z— (p ®q -- Q ASS — 6130/ ,S- Lot?No. 3J
Site Plan Name: Block No. (Q 1
Project Name:
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New Electrical Meter Second Electrical Meter
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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:. qr. (� } Sq. Ft. of First Floor:
Cost of Construction:, $ C) Utilities: _Sewer _Septic Building.Height:
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Name �
OCC-�- :�\G` Name:
Address: (( f 4C,YV\, Company:
City: C4 - ky CA- State: Address:
Zip Code: 3-4CAC6Z Fax: ---- City:
State:
Phone No.-1-11- `7C)�-'>-
Zip Code: Fax:
r503�
E-Mail: U 1 \ '�., �AY!/� Phone No
Fill in fee imp 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
Name:
Address: State:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Z• Phone:
MORTGAGE COMPANY: _'Not-Applicab e
Name:
Address: State:
City:
Zip: Phone:
BONDING. COMPANY: /Not Applicable
Name:
Address:
City:
Zip: Phone:
ip.
tion is hereby made to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Applica
I certify that no,work or installation has commenced prior to the issuance of a permit. ,
able Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
St. Lucie Count yy makes no representation that is granting a'permit will authorize the permit, holder to budd,the,subjectstructurc
which is in conflict with any applicable
structure. Please consult a 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 des and gteeuc ethat
I will,
in all Amendmentsperform the work
in accordance with the approved plans, the Florida Building
The following building permit g applications
fences, walls, signs, screen rrooms and am undergoing a,full ccessory sory uses to another non-residential use
acncurrency review: room additions,
cessory structures, swimming p in twice for
WARNING TO OWNER: Your failure to, Record a Notice of Commencement may result in pay g,,
improvements to your property: A Notice Commencement
first nspecfionslfy ou intend to obtain flnanc ng• , o sult
Lucie County and posted on the r bsitecommencing
before
with lender or an attorney before commencin work or recordingour Notice of Commencement.
Ak
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Signature of Owner/ see/Contractor s Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn (or affirmed) and subscribed before me of
Ph sical Presence or Online ZOotabyzation
this day of N lriJ
VLIQ
Name of person making statement.
Personally Kno n OR Produced Identification
Type of identifi tion .
Produced
n If
(Signature of Notary Publig State of Florida )
Commission No. (Seal)
REVIEWS
DATE
RECEIVED
COMPLETED
ev. 5
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or —onlineNotarization
y
this —day of
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
PLANS VEGETATION SEATURTL'E MANGROVE
REVIEW REVIEW REVIEW REVIEW