HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �I ®� _ ® I��
Date: ' o- Permit Number:
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3 F. -
RECEIVED
Building Permit Application APR ® s 2021
Planning and Development Services
Building and Code Regulation Division Permitting Department
SL Lucla County
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax: (772)462-1578 Gorrmmercial
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1411 WIN
Address: �S `/ k�✓/ �� Ike,-
Lot No./
PropertyTax ID #'. 3Q/
Block No.�—
Site Plan Name:
Project Name -z
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _
Shutters :-Windows/Doors
Sprinklers
Generator Roof: - - P-itch
_Electric —Plumbing — —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $; Utilities —Sewer Septic Building Height
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TName Name:
Address:
ap� � � I Company: .
City: /—; State: yr- I Address:
Zip Code:��gy% Fax:
I City: State:
Zip
Phone No. 779 4- �/�l�5� Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page( if different E-Mail
State or County License
from the Owner listed above)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice'of Commencement is required.
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DESIGNER/ENGINEER' _Not Applicable MORTGAGE COMPANY: _Not Applica ble
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 subjec
t 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.
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 THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Ignat Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF 1�' \—A)����y COUNTY OF
The forgoing instr ment wa acknowledged before me The forgoing instrument was acknowledged before me
this day of � ,2UA by this_day of 20_ by .
Name of 11eillson making statement. Name of person making statement.
Personally Known OR Produced Identification +'' Personally Known OR Produced Identification
Type of Identif" n \ Type of Identification
Produced (� UL Produced
(Signature of K REN� I LSEN (Signature of Notary Public-State of Florida )
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Pvau,
tate of Florida Notary Public Seal
Commission N __ °= ission #Mgl)207484 Commission No.
P? My Commission Expires
June 12, 2022
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DATE
RECEIVED
DATE
COMPLETED
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