HomeMy WebLinkAboutBuilding Permit Application All APPLICABLk INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -1 q
Date: ✓ r9Z t Permit Number:
RECEIVED
�■► MAR 12 2021
Building Permit Application Permitting Department
Planning and Development Services St. Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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- �E7y'�
Address: ' . Ll
Property Tax ID#: 3 lTc)3 ~S oQ-v c (Q clop g Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank ^Gas Piping _Shutt(Ps _Windows/Doors
_Electric _Plumbing —Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
7 --
Cost of Construction: $ , '�" Utilities: _Sewer _Septic Building Height:
4
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N'ame W i 11 '1 0i u.w IZ I AA` Q_ Name:
Address: re
I Z5 C�!a& CS - Company:
City: Ie(4- Stater Address:
Zip Code: Fax: City: State:
Phone No. 7 7Z q18 1(pp& Zip Code: Fax:
E-Mail: (1�JjA- Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required,
I f value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGfNEER _Not Applicable MMORTGAGE 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 ma.y 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON TIME JOB.SITE.BEIFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WVITI1'VO1JR` ' NDER OR AWATTORNEX,,BEFORE RECORDING YOUR NOTICE OF-COMME9CEMENT."
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Signature of Owner/Lessee/Contractor as Agent for Owner' `' Signature of Contractor/License(Holder I =
STATE OF FLORIDA / STATE OF FLORIDA "
COUNTY OF cI'Gr%fI-1 f-GrUC COUNTY OF
The forgoing instrument was y}ckn owl edged before me The forgoing instrument was acknowledged before me
this 12 day of A46?1&P' 2021 by this day of 20` by
Name of person making statement. Name of person making statement.
Personally Known '� OR Produced Identification Personally Known, OR Produced Identification
Type of Ide ification Type of Identification"1":`;
Produced Diver L-/Cerwe— Produced \ .
(Signature of Notary P c-State of Florida ) (Signature of Notary Pubiic-rState of Florida')'
Commission No. Off Da 3/(p7 (Seal) Commission No.
REVIEWS FRONT ZONING SUPERVISOR _PLANSf VEGETATION , .,SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ' "R'EVIEN/i ' . REVIEW
DATE
RECEIVED
DATE
COMPLETED
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oFs�..•' My Comm.Expires Aug 17,2024
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