HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO'BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application APR 12 2021
Planning and Development Services p,Pmltting Department
Building and Code Regulation Division g;.;t..�c�, ountv
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT TYPE:
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Address: 9�P'�
Lot No.
PropertyTax ID #:
Block No.
Site Plan Name:
Project Name:
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Additional work to be performed :under this permit-check all that apply:
Mechanical. . Gas Tank _Gas Piping _Shutters Windows/Doo'rs
. Pitch
Electric Y Plumbing Sprinklers —Generator - _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ g✓r' U�O� Utilities: —Sewer _Septic Building Height:
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Name Sy ✓s y Cks ; LAC Name. C' �f ��
Address: h�$S /V C.��/sue T f 6`'�s Company: �• 'r�r
State Address'
City:i
d I City: Gw",Xi; �Gt"t, State:
Zip Code: Xll y- Fax:
Zip Code:Phone No 7
3S!�ioP3 Fax:.7�a3.f/a-?Sss'
Phone No. -
E-Mail:
Fill in fee simple-Title Holder on next page( if different E-Mail G �Zs � hc
C>�y`n tie''
from the Owner listed above) State or County License eF<
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.
51
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: FOUR 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
9VI U LAN®ER OR AN ATTORNEY BEFORE'RECORDING Y4ft
ICE OF COMt19ENCEMENT.,,
nature o caner/Lessee/Contractor as Agent for Owner i uractor/Li ense Holder
STATE OF FLORIDA STATE OF FLORIDA L�1C`�—
COUNTY OF e 30, iL COUNTY OF
The fo oing instr en was acknowledg��efore me The f oing instru we acknowledpA'?efore me
this day of 20_ by this day of , 20C.X by
Name of person m king statement. / Name of p�ogtatement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identif n Type of Identific � �L
Produced Ni I Produced
(Signature (Signature o gtAq&,,yblic{� FRf§P FE SEN
_a�;�,�:�,Sta.telorida Notary•Publicav vY 6K,AREN S. NIELSEN =* sion # G($�1��j484Co.mmissio 11f�P s =Stare of Florida-Ndt �lpublic Commission oaOFf� mmi:.sion Expires
=* Commission# GG 20..1484, ''�� ��` .jun:.'12, 2022
My Commission Expires —
nn ne RVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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