HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � � oc Oa I Permit Number:
ILRECEIVED
"I RECEIVED
11 .
0 FEB- 0 4 1011
° °� BuildingPermit Application pp Permitting Department
Planning and Development Services St. Lucie Countv
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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PERMIT APPLICATION FOR:
r, ;TaxzlDx#.='�0�`�w OOP' G Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION ��14
5
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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:
st`of GonstrR-0n: —Septic
$ � �j(�(� Utilities: Sewer _ Se Building Height:
OWNER/LESSEE°-�
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��-CONTRACTORS
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ame ov-n OM..
Name:
Company:
ddress: 660gi A) t.) F L%w
,
Cgty: 1'04 Sf LHC. r State:
Address:
City: State:
PC o d e: 314 f g 6 Fax:
gone No. 17X76' - / f4 5
Zip Code: Fax:
Phone No
ENMai1: 13110t V 0i 6-in Wi 1, , e-0 M
4as�
Fill in fee simple 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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SUPPLEMENTAL CONSTRUCTION :L'IEN <LAWJINFORMATION
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 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
wi er orO attorney before commencing work or recording our Notice of Commencement.
Sig t,i 6.-oE:4; a " Lessee/Contractor as Agent for Owner
-MaSTATE
Signature of Contractor/License Holder
OF FLORIDA
STATE OF FLORIDA
COUNTY OF oL
COUNTY OF
Sworn to or affirmed) and subscribed before me of
t/ P ysical Prese or Online Notarization
this iT day of 2020 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
":1 0 M\J CIA I �'Lon 0�1
Name of person mak ng statement.
Name of person making statement.
/
Personally Known OR Produced Identification {'
Personally Known OR Produced Identification
Type of Identifi _t# on
Produced / L
Type of Identification
Produced
X' Cf�
Si nature of N �� c+�+�_cio
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(Signature of Notary Public- State of Florida )
. KAREN S. NIELSEN
4�Y PUB
Commission No. ;:° `:State of Floritg�tary Public
=d *= ommission # GG 207484
OF Ft°pO� My Commission Expires
11
Commission No. (Seal)
REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
� sLix3a.+i
FRONT
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20