HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAtB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` (, Permit Number:
SuQ - - BuildingPermit 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:(k4'
Address:
Property Tax ID #: t 1 Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter 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: Sq. Ft. of First Floor:
Cost of Construction: $ 09D Utilities: —Sewer _ Septic Building Height: _
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Name Q�
Name: '
Address: 1
Company: C
City: v Ct State: B
Address: C rnrnefe"_
ZipCode: Fax: i,\
City: t State :
Phone No. 5 6-()L
Zip Code: Fax: �C
E-Mail: -A')4M 1 00M
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Phone No If If
Fill in fee simple Title Holder on next page ( if different
E-Mail ' covin_
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDEIR A AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C MENCEMENT "
Signature of Own contractor as Agent for Owner
Signature of Contractor icense Holder
STATE OF FLORID
COUNTY OF Q��)o
STATE OF FLORI
COUNTY OF
The fo omg instryment was acknowledged before me
this ay of _t�.l . 20 by
The fo oing instr ent was acknowledged before me
this da o 20 by
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Name of person makink statement.
'Name of person statement.
Pe rso ally Known OR Produced Identification
Personally nown OR Produced Identification
Type f Identific on
Type of Id nti i tion
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Commission No. / Notary Pub}i�� St�
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:° 5�' Notary Public - State of Florida
Commission No.
Commis
Commissilli 034737
My Comm. Expire
,` My Comm. Expires Sep 4, 2024
Banded throu h National Notary Assn.
SEA TURTLE
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW,
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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