HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLEVINFQ MUST BE COMPLETED FOR APPLICATION TO:BE ACCEPTED
Date: f �� Permit Number:
Building Permit Application
Planning and Development Services
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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Address 646
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Property Tax ID #: Cvz�> Lot Na.
Site Plan Name: Block No.
Project Name: 22., _ C_
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Additional work to be performed under this permit—check all that apply:
_Mec apical _Gas Tank _Gas Piping _Shutters —Windows/Doors
lectric _Plumbing _Sprinklers Generator _Roof" Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
/ J o.
Cost of Construction: $ / — Utilities: _Sewer ,Septic Building Height:
11
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NameV �"09 P/ %5 Name: -
Address: G°ap 5 Company:
City: Rv ,� IGG�`� StateJ1ls Address:
Zip Code: Fax: I City: State:
Phone No. Zip Code: Fax:
E-Mail: ('i/�r✓ Pi ✓SGj/ G,✓ Phone No
Fill in fee simple Title Holder on next pag (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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
OR
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 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.
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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE J B RE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEIN - R AN TT O NEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � " � STATE OF FLORIDA
COUNTY OF ��- �c.��C COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_day of ,20_ by this_day of 20` by
ab h, cal is
Name of person making statement. —� Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �� Produced
(Signature of No r ubli o P�4Flgrida) -I nature of Notary Public-State of Florida )
r-Notary Pu li
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Commission N SARy oQP." (Seal) t,n Expire C mission No. (Seal)
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REVIEWS TMyC r I( ota� �tJ ISOR PLANS - VEGETATION SEA TURTLE MANGROVE
COLT Oc ��iG2> p� W REVIEW I REVIEW REVIEW REVIEW
-DATE
RECEIVED
DATE
COMPLETED
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