HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z-I "I��
--r' Permit Number:
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Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Address: I IOU
Property Tax ID #: 2
Site Plan Name:
Project Name:.° f l�
Commercial Residential
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)CATION:
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—CWS
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
:_CONSTRUCTION LNFORMATtON:
Lot No. IZ - /6
Block No.
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 _X Roof Pitch
Total Sq. Ft of Construction: 1 �'� Sq. Ft. of First Floor:
Cost of Construction: $ - %Ur 9 f Utilities: _ Sewer _ Septic Building Height: 2
OWNER/LESSEE: CONTRACTOR:
Name Name: 1
Address: _ Company:
City:��' Y' State: Address: 1� i7Ct-� I
Zip Code: 2 _ Fax: City: I" Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No .2 --I � Is 0
Fill in fee simple Title Holder on next page (if different E-Mailk It
(�
from the Owner listed above) State or County License_ -7 u.
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 CONS'
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
IUCTiON LIEN LAW INFORMATION:
Not Applicab
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
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 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
nse Holder nutre ofC orice
STATE OF FLORIDA �� �, AUNTY OFORIDA
COUNTY OF {� '� f'�
Swor to (or affirmed) and subscribed before me of
h icai Prese or Online Notarization
this__ day of i ArkZ1.5er20210 by
Vim
Name of person making statement.
Personally Known _ OR Produced identification
Type of Identification
tleire of Notary Public- State of,,Eior„(da)
.. p0.Y Pad, KATFiERINE HAVENS
MY COMMISSION #GG16
Commission No. all EXPIRES: DEC 04, 202
9' A
I , F,� Bonded through ist State !nsi
Svrn to (or affirmed) and subscribed before me of
Pbysical Pres qe o Online Notarization
this�day of 2020 by
11
Name of person making statement.
Personally Known k OR Produced Identification
Type of Identificati n
r rootary F'up))c- W.' t lorid a JATHERINE HAVENS
A
1'rOn1SSION #^
No. �>�� 'oP'` 1G165030
o�Ra ,.,,..- : DEC 04, 2021
Bonded through 1st State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
COMPLETED