HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
Residential
PROPOSED IMPROVEMENT LOCATION: i
Address: 19 e r.
Property Tax ID #: 0 o) - GnQ - n yl 3 - QQO - 3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
I t-.c I r: I I .: c, _ -
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ a_�) - 00 Utilities: —Sewer _ Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Q
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Name:
Address: 4q
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Company: V
Address: 9-11 rCfl
City: f+ . Piy- .'P State:' ,
Zip Code: s Is C) Fax: '-'
Phone No. "'-
City: ESA l Stater
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Zip Code: P9 Fax, ----
Phone N 1 i6-01 —Irk
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E-Mail Coll
E-Mail: --
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
IVULILC V1 wmmencemenr is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 bylaws
rules, 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.
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Signature of Owner/ Lessee/Contractor as ent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA I
STATE OF FLO�IDA
COUNTY OF S+ hick
COUNTY OF J-i- L 1
SwoJn to (or affirmed) and subscribed before me of
N
Swbrn to (or affirmed) and subscribed before me of
Physical Pres ce or Online Notarization
this 5'`` day of 202,�,, by
Physical Presence or Online Notarization
S�'' —Sor'1
this day of 2021 by
I(A_M h r r n
Name of person making
Name of person making statement.
/statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Prody,ed
Produced_
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(Signature of Notary Public- State of Florida)
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(Signature of Notary State of Florida )
Commission No.�7�� �& (Seal)
� �Public-
Commission No.�/ / 3
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED ,.��"r"r"�•, RICHY rr*�Pi,., RICHY GOM S, JR.
DATE =;Mo a'v Pohl:c•Stat of Florida .:
COMPLETED ;a Ca"'T':'"' tr Gt, 966763 �, Commissi.On k G 966763
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March O8, 2024