HomeMy WebLinkAboutBuilding Permit Application CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
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Building Permit 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: . a
PROPOSED IMPROVEMENT LOCATION:
Address: \ ��.
Property Tax ID#: 01�- �1'�9 c��,�3,— 4n�a -c'� Lot No.
Site Plan Name: Block No.
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Project Name: ®'\
DETAILED DESCRIPTION OF WORK:
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�o�L�Co C� SAS ay
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: �� l.cKj
Cost of Construction:$ Lgtj�' Utilities: Sewer —Septic Building Height:
OWN ER/LESSEE; CONTRACTOR:
Name L5L"> - Name: �1►. `C 2�. k�
Address:3"303 Company:Vt)Z
City: State(_ Address:!Mz,t 10% \yam _
Zip Code: ����"a• Fax: City: Stater
Phone No. Zip Code: 3:t-) Fax:
E-Mail: Phone No t,-\ol,,
Fill in fee simple Title Holder on next page(if different E-Mail sky
from the Owner listed above) State or County License CSC\3�SZIaCn q
rt,
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.
S,IJ:PFLEMENTA:L CONSTR'UCTPON LIEN LAW INFORMATION;
ra r - .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: one Zip: one:
FEE SIMPLE TITLE HO ER: _Not Applicable BONDING COMPAN o �licable
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.
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
improvementsrap
r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County aed on the jobsite before the first inspection. If you intend to obtain financing, consult
wit lender orrne before commencingwork or recordingour Notice of Commencement.
Sign atur o Own Less Contractor as nt for Owner Signa f C c or icense Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn or affirmed)and subscribed before me of Sworn or affirmed)and subscribed before me of
P ysical Presence or Online Notarization hysical Presence or Online Notarization
this day of @fit � ,20Zby this% day of �@y�, 20'%by
Name of person making ZOR
t. Name of person m=OR
t.
Personally Known duced Identification Personally Knownoduced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary P i i of Flori ry� LOO/!fT (Signature of Nota blic-Stat C,, Q�' B
MYA MIyIISSION GG143436 so LOVE T.
Commission No. EX eI1► Commission No. yw�;( a�pMMISSION#GG1
September 17,2021 � ;: 36
EXPIRES September 17,2
' 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.