HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L�,
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L- L `� `Z LL, `� _Y^ 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:
Address:. i ('ici.(�'�;�,�
Property Tax ID#: L-�1�%``)i7`7-1�;c),''�i!_��^� �l Lot No.
Site Plan Name: " j' ' �,�';��� �i; �; Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
1.If W Use _ s1� new c oil ��afe
no piuil}gtrl q, no i✓CLJL)Uy
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
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1500 Sq. Ft. of First Floor: 15 0 0
Cost of Construction: $ 2A 0 9 G? Utilities: —Sewer Septic Building Height: ( i
OWNER/LESSEE:
CONTRACTOR:
Name":;�L'o,\ %;` � };
Name:
Address:r%��i,��i��rrL� 1[i
City: ` � � ;j
4 C_ \�� ,�' State: � i
Zip Code: Fax:
Phone
Company:
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Address: s
City: State:
Zip Code:' 2� )� Fax -
Phone No ?7 7 L - I �i � � �D
E-Mail:q\i �����t�^l �r�� .(� _';\r\If' i�%o';S • �.L I��
Fill in fee simple Title Holder on next pdje ( if different
from the Owner listed above)
E-Mail .11� � 1 �" I(Fi��`,I�r �' ` • l `(�
State or County License es 1� ` (l]
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
StJ�p�L;EIV(fiNTkL �-O��U:S��iiuCTt��I� �Ll,�d�l t:A.�l1! I:Ik�F,Of�{�71�T����1 .-
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
.130NJO 9 (GOM,10ANY: 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 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF
COUNTY OF C
COUNTY OFORIDA
Swor o (or affirmed) and subscribed before me of
Ical Pr r Online N tarization
Svvprn to (or affirmed) and subscribed before me of
-4$' Physical Presence or Online Notarization
I
this of Y v 202, by
this 29 day of MA- R-aH 2O20 by
Name of person making st ment.
Name of person making statement.
*
Personally Know OIR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
ProduceA n
Produced
j
(Sign 6ture o Notary Public- State of Florida)
(Signature of Nal fblic_Sta 4dQ4 x-•-�: =:
y "
IMARIA R. BURGIN
Commission N ,''YD "`•. RISTINE HO
Commission Nvy ' 'I fl_` = Commission 1,' GG 3 (�f�l)
as r; Notary Public - State of Florida
Sl . 7 I
T Lxpires August 25, 20_3
Commission HH 073152
h n, ,•i T, ,T,., h 1.
My C
mm. Expires Jan 2
, 2025
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Rev. 576720