HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: V Permit Number:�� `w `z3
Cl ; RECEIVED
p,. Building Permit Application
Planning and Development Services �A� ® i)zo
Building and Code Regulation Division Commercial Residential Permitting Department
ty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: OC ® I: a _ y
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Property Tax ID#: � O�b�� ®QD Lot No.
Site Plan Name- Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
ti apt e 6 --7
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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: p Sq. Ft. of First Floor:
Cost of Construction:$ L MOO: ® Utilities: —Sewer —Septic Building Height:
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30VVNERLESSE - a
O. 1R/aCTOR �� - `
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Name Name:
Address: Company:
City: State: Address:
Zip Code: 34a qle Fax: City: State:
Phone No. — ���✓' i IllCode: Fax:
E-Mail: S 5 ililftc hone No
Fill in fefsimplt Titit 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.
SUP full L O; „�U r Ll y tJV;04,R, I
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 grantin.g 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 lencjqr or an attorney before commencing work or recordin our Notice of Commencement.
Signature Owner/Lesse Contractor VAgent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �-- t-Q r_Ve COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
_Physical Presence or Online Notarization Physical Presence or Online Notarization
this '1 day of 4:�*Q,4\ 20210 by this day of 12020 by
Creo�'g�\d, WGSO�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificgion Type of Identification
Produced- �`" Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. -(Seal.)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW. REVIEW
DATE
RECEIVED
DATE
COMPLETED
�ev. 5/6/20