HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO, MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � ,' � / 7• e;24 Permit Number:
ST LuciE
COu�lT'Y..
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: � &n Y e W A q
Address:
RECEIVED
FEB 17 1011
permitting prpartment
St. Lucie County
Residential
Property Tax ID #: 1 d �� l0 ®L? ' Lot No.
Ci+e Dl n rklRlnrlr Kin
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric i Plumbing _ Sprinklers ^ Generator — Roof Pitch
Total Sq. Ft of Construction:
I r
Cost of Construction: $ ,� i._Cap
Sq. Ft. of First Floor:
Utilities: _ Sewer Septic Building Height:
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OWNER/LESS ,E� �T T�'i',Ry=a,
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Name
Name:
Address: %
Company:
City: State:
Zip Code: Fax:
Phone No. —U6120
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Address: _7QQj 4U
City: �C� Stater
Zip Code: .S1 Fax:
Phone No 4 — 46 oZ
E-Mail—Doart6yi
E-Mail: h
Fill in fee simple Title older on next page ( if different
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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SAP EMIENTq;L C0�1SS��R�U,0 LIE
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 Coat and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wit-Klendex-fman attorney before commencing work'or recording your Notice of Commencement.
Signatu4'of Owner/ Lessee/Contract as Agent for Owner
STATE OF FLORIDA
COUNTY OF
SW to (or affirmed) and subscribed before me of
Ph sical Pre se e r Online Notarizatio
this day of -il - by 1
r ),
Name 6f person m king tatement.
Personally Known '`/ OR Produced Identification
Type of Identi is
Produced
V
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of .2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of N gr HR (Signature of Notary Public- State of Florida )
I ab� AUD GG 300817
iy_ ° 'F mycOMM1SSI0Ni# (Seal)
Commission No. • :#- PIRES:h,4 9� 10,2023 Commission No.
y cublic Undervnters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED