HomeMy WebLinkAboutBuilding permit appAll APPLICABLE
Date:
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
11ding Permit ApplicatiBuon
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: EL�C�`R�
PROPEOSD IMPROVEMENT LOCATION:..........
Address:
Property Tax I D #:
Site Plan Name
Project
Name:
f-a
CA L
Lot N o.
Block No.
DETAILED„DESCRIPTION-OF WORK;Won
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New Electrelcal Meter Second Electrical
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MATION.
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Additional work to be performed unde
Mechanical Gas Tank
Electric Plumbing
r this permit - check all that apply:
_Gas Piping
_Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Shutters
Generator
Sq. Ft. of First Floo
Utilities: Sewer
moso--h
_
t
�
r
Windows oors
Pond
MEWNWO
Roof Pitch
r:
_ Septic Building Height:
OWNER/LESSEE � CONTRACTOR :
Name Yl 1e,1� a-�OY�D.�C� �'C`X1P.S Name:
Address: om an��J�k� 1�2y:NlQ�'I�A
City:.0� �.RC� State:�-�� Addresso \0\0�
Zip Code: Fax City: 1EP_C�� State,.
Phone No. S L4 - al (0 Zip Code: �J���a— Fax: -mqp�
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E-Mail: t'S �b�S � ���Shc1��, C..0 0 n2i Phone No -;4�
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Fill in fee simple Title Holder on next page 'if different E-Maol
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW'INFORM.ATION.
DESIGNER/ENGINEER:
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name.
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Not Applicable
me:
Address:
City: State:
Zip: Phone:
6
Not Applicable � BONDING COMPANY: _Not Applicable
Name
:
Address:
City:
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 orinstallation 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.
I swr I W I I %we TV to 1 0 P61LV %on I I Nam 9 5 1 1 .1 0 0 0 40 -0- r rw 9
o another non-residential use
accessory structures,, swimming pools, fences, walls, signs, screen rooms
and accessory uses t
WARNING TO OWNER: Yourfaeilure to Record a Notice of Commencement may resu
improvements t
Lucie County and hosted on the iobsite betore the ti rst inspection. If you i
It in paying twice for
o your property. A Notice of Commencement must be recorded in the pub
Lkl:n
with lender or an attorney before commencing
Signature of 0
Lessee/Contractor as Agent for Owner
I -A ... ...
lic records of St.
4h
ntend to obtain financing, consult
work or recording your Notice of Commencement.
STATE OF FLORIDA
COUNTY OF
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Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this gltD day of ry)ayt-E , 202
by
-u� o�
Name of person making statement.
Personally Known %/ MEMENEEM"r OR Produced Identification
Type of Identification
Produced.
(Signatur4Jof Notary Public- State of Florida )
Commission No,C-.&nrG
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev.MO5767ZU
FRONT
COUNTER
State of Florida
Ma�ga�et E montepare
c_ My Commission GG 2149,90
# A. Expires 6/05/2022
REVIEW I REVIEW
Na
Signature o
ontractor/License Holder
ACJZ
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STATE OF FLORIDA i�
COUNTY OF
Sworr(tco (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this � day of fNN)CQrCV"" , 202
by
Name of person making statement.
MYC MMMAina C-2r-2--714Q-Q-(1
I
E.Montepare
Personally Known N/ OR Produced Identification
Type of Identification
Produced
(Signatur of Notary Public- State of Florida
ommission No..
��IUoTa�r ublic State of Florida
Margaret.
7a p Ex r 06105/2022
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