HomeMy WebLinkAboutSelph Building ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
t2, L
Building Permit Application
Planning and Devetopment Services
Building and Code Regulation Division Commercial Residential
2300 Virgfnia Avenue, rott Pierce rL 34992
Phone: (772) 4624553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Property Tax ID
Site Plan Name,, It"
Project Name: -.2.
DETAUD DESCRIPTION OF WORK
New Electrical Meter ----.Second Electrical Meter
I C�l �STRU�j:10�1:1 N FORMATION:
Lot No,
--
Block No.
Additional work to be performed under this permit —check all that apply:
--Mechanical — GasTank — Gas Piping Shutters Windows/Doors _ Pond
— Electric — Plumbing —Sprinklers — Generator Roof --- Pitch
Total Sq. Ft of Construction- Sq. Ft, of First Floor: qoo----/
Cost of Construction: $ jMUtilities: --Sewer VSepfic Building Height:
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City. State:' �L Address: 1096 21
Zip Code- tJLCI�.fl ` State; Fax:----, City: S�Wal�cyl
Phone No,-'-7,, 2Z L 1) Zip Coale : _,I, 7,0 Q Fax:
J_ - 7oc rLa
E-Mail; Phone No aTkIL-1,4611
Fill in fee simple Title Holder on next page (if different E-Mail (el� �1, 1Y -YN1
from O the wner listed ora
l State or County ace l��B
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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,
TAL 00M.
$UP.. _ -
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� Applicable
DESIGNER/ENGINEER: ENGINEER: Not App
MORTGAGE COMPANY: Not Applicable
Name: _,_.:_._
Name: .
Address:
Address:
City;State:
City: State:
Zip: Phone_ ._.�._
Z;p: Phone: - --
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: , , Not Applicable
Name:
Name:
Address;
Address:
City.
ItY• _.....
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the woric ana instaimuon as inoicaxeo.
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 Aeration rules, bylaws gr a l covenants that may restrict or prohibit such
structure. Please consult with p our Home Owners Association and review your dee�for any restrictions which may apply.
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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 addition,
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
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
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1t.�1• ■V■.Ma.r• M.. Mr�r...r. rvsv.v .�r..�...�.. __ _
__ � ��-_ _--___ _ __ _ _ _ _- _ _ _ _ _
Signatu Owner/ ! see/Contractor as Agent for Owner
3IgnatJ9&bf Contractor/Llcense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF X: t% oK-Y-\ ��'
COUNTY OF�
Sworn to for affirmed) and subscribed before me of
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
,!'Physical Presence or Online N tarization
this 4 day of ou�-c � 202 by
this ____, day of , 2o2o by
O_C�� SL,, i� 1Y-15
0,4 " C, s- 4
Name erson makift statement.
Name of person rnaki
Personally Known OR Produced Identification
---------------
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,ti1Y PtF! •. AAA.��� Gaon
Personally Known '•� R ro u --
:." :* Mission C -3628`4
Type of lde fication
Produced C.- XJ
Type of Identification =u= • - �-
Produced - y��� •�° Expires august, 20,3
Tru Tray F8in�lnsuranq�ad-385-70
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(Signature of Notary Public- Slate of Florida }
(Signature of Notary Public- State of F16Ada T
Commission No. am& Nary PubgSSeal)
Commission No. (Seal)
State of Florida
ma N
REVIEWS
FRONT
_1409069
Z! UNI G-
SUPERVISOR
Pi.ANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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