HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Sc'u, L-r. cIt'
J' J' J
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
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Address: . so .Em «
. wtrj AveF-� Q) [ f F 3 9Y j—
Property Tax ID#: �3 8 9 — yA) [ 0() a oi U00 , A Lot No. �
Site Plan Name: M c � Block No.
Project Name: Mr---1—a pe!�
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank ^Gas Piping _Shutters _Windows/Doors Pond
vlflectric Plumbing _Sprinklers `Generator _Roof ' Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ oat) Utilities: —Sewer —Septic Building Height:
OWN€RAESSEE: CONTRACTOR:
Name_ [zf wn I C- Lc /Y% Name:= r %qy �"r0IC(CtCre,
"Address: �$O Mt,c►kd Ave Company:r j ��( i/Yla Pn2
City: IF-- Y,,o c.. State. Address: S.W CN )Lj rC'K-6 r-G(e
Zip Code: LV1L15 Fax: City: �Sl� Stater
Phone No. ---T
�M).___ -3=2.3 Zip Code: Fax:
E-Mail: ( _ �r�_�1 13'Qlt ��p�4s.v? P,,m Phone No
Fill in fee simple Title Holder on next page(if different E-Mail Z..DCeI l_S&q yak aa
from the Owner listed above) State or County License f'OPC ySq Iy I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is softd Fp�q�
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is requ" a Tr a vftz�
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: til I�ot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: of Applicable
Name: r7c§. f \C a,M Name:
Address: -7 SO Ir0869&ak� Adc Address:
City: F-k- ` c F k City:
Zip: 3%�'t l4s_ Phone: '7- 2 ,�- 313 - 133 Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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,wails, 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
with le r or an attorne before commencing work or recording our Notice of Commencement.
Signa ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA I
COUNTY OF P0J m &a,c,h COUNTY OF
Sw to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
l
y- Physical Presence or Online Notarization _Lf!, P'hysical Presence or Online Notarization
this�( _day of Apr:( 202$ by this day of kTr;t 2021) by j
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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
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(Signature oT Notary Pu is- lluri 11
(Signature of Notary Public-St e 11 F o i
Commission No y� NcaryPWft3Ur1�dFb(Wa G 93i71 +�' J�eerestwaFW.*
Trai:146M1) Commission No. ?
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.