HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — ��_ Permit Number: QA O
_ 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: She
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Property Tax ID #: 2-01 CA
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 _Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construct' n: Sq. Ft. of First Floor:
Cost of C .5,struction. Utilities: —Sewer —Septic Building Height:
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Address: -70 ,M ►� Company:
City: State: Address:
Zip Code: Fax: City: State:
hone No. , Zip Code: Fax:
-Mail:Ot c � 1 5CPhone No
Fill in fee simple Title Holder on next age ( 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.
DESIGNER/ENGINEER: — Not Applicable
Name:_
Address:
City: _
Zip:
Pho
State
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: -Not Applicable
Name:
Address:
Citv:
Zip: Phone:
State:
BONDING COMPANY: Not Applicable
Narne:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to clothe 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, ,l 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 ARID
POSTED ON THE .SOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
,r,r ��. wvy nvKf^nie nvr. r. Annaldvna 10 WnTirF nF C[)MMENCEMENT."
"I I H I wvee a_EnlUCK Uae K n %J at®
R
grr��a,-0ner/ Lessee/Contractor as en_ for ner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 9—Lg
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _"day of 202Aby
this day of 20_ by
NrrM13W=
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identific ion
Produced F C., ALL-
Type of Identification
Produced
�v
(Signature of Notar
(Signature of Notary Public- State of Florida )
LE N
:state of V4UGFiN
Commission No. �* _ f�a-Notary Public
Commission No. Seal
oPr ommission # GG 270079
'.;o My Commission
Ex '
2022
REVIEWS
FRONT
ZONING
�ry
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/-//19