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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED CNO Date: Permit Number: CL - e Building Permit Appl' ation 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: Q PROPOSED IMPROVEMENT LOCATION: Address: t Property Tax ID#: c)00 Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: �TU g • l 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 iWindows/Doors „Pond —Electric _Plumbing T Sprinklers Generator _ Roof Pitch Total 5q.Ft of Construction: 2 Sq.Ft.of First Floor: Cost of Construction:$ 'J Utilities: —Sewer _Septic Building Height- OWNER/LESSEE: CONTRACTOR: Name Name: Address: Company: City: State -Address. K ( a Zip Code: Fax! City: Stater Phone No. 7 Zip Code: Fax: E-Mail: Phone No=`i.;i- rJ 3- LbD�l Fill In fee simple Title Holder on next page(if different E-Mail S4a-_kSl P_Y rn �m from the Owner listed above) State or county License If value of construction is 25M 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. SUPPLEM ENTAL CONTT, UCTION LIEN'LAW INFORMATION DESIG GINEER: ,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 BiAding 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,wails,signs,screen rooms and accessory uses to another non-residential use WARNING'TO OWNERAted ilure to Record a Notice of Commencement may resu paying twice for improvement to yperty.A Notice of Commencement rnu a reco de in the public records of St. Lucie Coun a Pn the jobsite before the first inspectio .€ ou I end obtain financing,consult uyith lender r a before commencin work or recordin o r N tice of ommencernent. Signature of ner/Lessee Contr ore Agent for©wner Signature ontractor/License H der STATE OF L RIDA STATE O F ORIDA COUNTY F d-n 1 - COM ITY 0 Svegm to j a rmedl and subscribed before me of Sworn to r irrned)and subscribed before me of Physi resen ear line N tarization Fi�ys al res ce or ine N tarizativn this day of 202� by this d of 20f by Name of person making statement. Name of person making statement. Personally Known X OR Produced identification Personally Known- k - OR Produced Ide ti cation Type of Identification Type of Identification Produced Produced Alf�1 (Signature of Not Public-State of FI ( ign ure Nota �.(L.MON + t+loiery PuNc SEW of Fiar;da � �L;b156t4H .'TfNo. o e €(8ii M R�GG Commission No. _ r 4 26 �q', mttii5Sl0n WISU )A a OV=024 % REVIEWS FRONT x li !•♦ lsOli! iLANS VEGETATION SEA TURTLE MANGROVE COUNTER R<:3iI��� REVI �IIEW REVIEW REVIEW REVIEW DATE RECEIVED ,i� Ali P�AGe Naiary 5at'� �p` DATE r}�� llifii11111���� COMPLETED ev.