HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFt3 MUST BE COMPLETED,F'OR APPLICATION TO BEACCEPTED
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Date. Permit Number- _
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-: Buld.�ng Fermat Appl�catton
Pldr►nmg and Deuetopment Services
8ui(d►ng artdCode Aegulatrbn Qrvisron. COm. .OrGta) R25tdE'I1ti }_
. 2300 Virg�ira Avenue;Fort Pierce r-L 349&2> - '
Phone.(772)462=1553 :Fax (772}462 A57$<
PERMITAPPU:CATION FOR AN
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Address + ` �1f1G('t �1D� l "
.Property Tax ID# r
: : � . Lot��hi
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Site P.Ian Name;
. Block N`o:.
t��TAtLEQQESCRIFTIE3N t7F 11�E3�tK � � � ��k � �� ���,
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N:e+v Elecf ical Meter Second ElectztcA Meter: .
c L S s. `"' 6 .-€h"k}t''"4,i
CENS�tUCTtN IiV� 4IYYf' {l e a g SeY 3a
> ...,..1tin.".M, �-c ',_ 3. ..... SGs-a- _.,.,:riur 4N+..Pa« w Yx?� 'f 3"tt:.- "{...1'fnv 617.r f's sj c,£`_ .. -n ..... .- ^.-•• --
Additional work°;tcr be:performed, under this perrnif:=check'all that-apply::
_Merncal< _ Gas°Tank; ^"Gas Prpigg Shutte Wmciaws/-Doors �_ Pond
ha
Electnc� _Plumbing: Sprinklers,, Generatgr _:Roof Pitch;
Total Sq :Fxbf.Carfstructjon: Sq, Ft;"'of First laoe:
Utilities Sewer, _Se, g"
Cost of Construction $ .. pt�c: Buildrrg Her ht-
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.Name ;
Address ' CampanY
City.. � _ . �. • State �Addross . _..- _ .
City
Zip Code Fax _.. ,
Phone"No ,
tp Cade
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P ho
E' ai ne No
Fifl�n feet Title Hoider nn next page(if different. E Mai(
from�thbi Owner fisted;,abo orve} State County Licens 1.
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f"constructron�s"25i10 armors,a.RECQRDED Notice of Commencement,is required
If value o ,
if,value of.HAVC<is$7,500 or"mvre,a RECORDED Notice.of Camtnenceinent it rei utred::
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surugtsr �r t,r �Ar rt PAra K _ E�
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DESIGN,ER/ENGINEEW N'ot_Applicabfe MORTGAGE COMPANY:; i'�Not,Applicable.
Name Name::..
Address;. . ` Address:..
City_ State City;: State >
ZIp; Ph'one Zlp. Phone:
_ ,., .
. _
FEE SIMPLE TITLE 6i01DERi Not Applica'b1e: BONDINGCOMPANY: Not Applicable
Name Name::
Adtlress 4ddress-
City Crty
zip, Phone:. Zrp: Rhone.
OWNER CONTRACTOR AFFIDVIT Application is hereby rriaoeto obtain a permit to do the work:and Installation as°indicated:
..
fcertify.that no workor.,installation{has commenced�pr or to=the:i'ssuance of a permit.:.
St.,Lucie Counttyy m.akes.no fepresentation,th`at is granting,a permltwill'authorize�the permit halder to build the subjectstructutd.
which is ineonflictwith any,applicable,Home Owners Association rules bylaws or'andcovenants.that may.restrict or.p�ohibit such
stru`cture.'Mease consu(tWith your,Home Owners.-Association and:reviewyour deed-for any.restrictions,.which mayapply,.
inconsideration of tl a granting of this requested permit;I do hereby agree that viriil,Wall,respeets,perform ttie work
in accordance.with the-approved plans,i e:dorida O lding_Codes:a'nd St:Lucie,County'Amendments.
t"ffe'i6flq,wihg bblidlhg.zpermit,appiicaeiohs.are'exempt-ftom.uhdL%rgdihg,.'a"fulI coneurrency'review:'room.addition!�:
acceSSorystructUres;swimming`,poolsi..fences,,wafls.signs,_screen rooms and accessory uses to another non-residentiaf use
WARNING-TO OWNER;Your failure to Record a Notice of Commencement may eesul.i"in paying twice fpr
i`mprovementS to,you property. A Notice of Commencement must be recorded in•the public records df St`:
Lucie:Co ntya ,d posted-n the jobsite before the.first Inspectlon.;afyou intend to or3tain financing; consult
Withcle r r n attorn 'before Commenci;n worl4:br;reCOrdjng<your Notice af_COrrtmeneement:.....
Signature'O „hierf .S e. ' ntractor as Agent foc Owrier, Signature of Contractor/License alder-
STATEOF FLOR STATE'OF FLORIDA,
t0UNTY.OF ' N\ erg COUNTY`OF:
sworn to'(or affirmed)ah6subscribed before me of Sworn tc (or affirmed)and'subscribed.before me of
X Physical Presence or Online Notarization Physrcal R�esenee or Online Notarization
this Zts day of.. .,21p(O ,. _,;2024.by this. day of` .02t),by
Name,of person`making:statement: Name-of person.making.siatement.
Personally Known OR Produced Identification Personally KnownR Produced Identification
Tylae d Identi on., Type ofldentiffca#ion
Produ ed Produced
__ -
.V
.(Sign face"of Notary Public=Stat .
Lg ,q2 jULLIVARI {Signature of Notary Public-Stafe,of Florida}; "
of
iv1iJTA Y PUBLIC
i °
Commission No:
ta;rEd�-bAbA Commission No.,. {Self)
G3 294-35
YCE is
REVIEWS FRONT .ZONING' S,UPERVISCIR: PLANS VEGETATION SEA:TURTLE MANGROVE:
. . ..
COUNTER REVIEW REVIEWIEW ;REVIEW
DATE REVIEW REVIEW REVIEW
,-RECEIVED
DATE _.
COMPLETED
ev:.516120