HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE NFO UST BE COMPLETED FOR APFUCA71ON TO BE ACCEPTED
A" APPLICABLE
NTODate• Permit Number• L6-bi
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Building Permit Appli tion
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginla Avenue, fort Pierce PL 34982
Phone: (772) 462-1558 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address u AL6 r, Io+
Property Tax ID M. Q i Lot No.
Site Plan Name: 12 10 IL U Si C Block No.
Project Name;
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit— check all that apply;
Ve
hanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Pond
tric Plumbing Sprinklers ,Generator —Roof _ Pitch
Total Sq. Ft of Construction; Sq, Ft, of First Floor;
Cost of Construction: $ Utilities; _Sewer _Septic 8ullding Height:
ww
Address; — ul"x'
CityIF
: -4- State: �J
Zip Code: D Fax:
Phone No.
E-Mall: / IVI
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
Name;
Company:
Address:
City, State:
Zip Code: �. _ Fax;
Phone No
E-mail
State or County License
If value of construction Is 2500 or more. o RECORDED Notice of Commencement is reau
If value of HAUC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
V Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name;
Address:
Address;
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Narne:
Name:
Address:
Address:._
_
City:.
City
Zip: Phone;
Zlp: Phone. -
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as Indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St U�je Count makeg no repre$ent tian that is granting a permit will authorize the permit holder to build the subject structure
w�fc Is In 4on Ict with anYy� ppplicab�e Home own rs As}optatlon rule$, bylaws pran covenants th t may reStrio or prohibit such
structure. Please consult wtth your Home Hose
Association and review your deed or any restrictions whA 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 addltlons,
accessory structures, swimming pools, fences, wal Is, 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 pbying 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 lehder or an attornev before commencinsr work or recording vour Notice of Commencement.
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Sig ure of Owner/ Lessee Contractor as Agent for Ow- iner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
—Physical Presence or Online Notarization
_ Physical Presence or Online Notarization
this ____, day of .2020 by
this _day of 2020 by
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 Notary Public- State of Florida.)
(Signature of Notary Public- State of Florida )
Commission No. (seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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