HomeMy WebLinkAboutBuilding Permit App-VOID I
All APPLICABLE INFO MUST BE COMP ED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0 '�
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�F ° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential, ✓
2300 Virginia Avenue,Fort Pierce FL 34992
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: e
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PROPOSED"IMPROVEMENT LOCATION:
Address: 1�1� S 0
Property Tax ID#: 5)1- 00 5-Q 0`}5 -D 0Q Lot No.
Site Plan Name: Block No.
Project Name:
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DETAILED DESCRIPTION O WORK:
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New Electrical Mr h cond Electrical Meter
CONSTRUCTIOI4fNFOR TION: "
Additional work to be perfo ed under this permit-check all that apply:
_Me nical _Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
ectric Plumbing —Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq.Ft of First Floor:
Cost of Construction: 040 Utilities: _Sewer Septic" Building Height:
OWNER/LESSEE: CONTRACTOR:
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Name S Name:
Address: Company:
City: State: L Address:
Zip Code: 349.59 i Fax: City: State:
Phone No. ' FJ" 60- ACID, Zip Code: Fax:
E-Mail: sso 1 DO 'COM Phone No
Fill in fee simple Title Holder on next page(if 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 HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGI EER: ! _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 0 Ali Name:
Address: 5 Address:
City: 'Slmort State: City: State:
Zip: Yiqclto Phone Zip: Phone:
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FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: j
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 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St Lude 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 befam wrnmencinework or recording our Notice of Commencement.
Signature of Owner/ ee/ ntra or as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF c Q 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 j
Personally Known OR Pro -Personally Known OR Produced Identification
Type of Identificati n t►*Y'w• KARI;AR Typ f identification
f : _
Produced q n �t.� �`' �_ Notary Publaps red
Commiss 74
My Comm. 2024
Bonded th ugh N Assn.
(Signature of Nota Public-State of lort a) g ature of Notary Public-State of Florida)
Commission No. (Seal) @ Commission No. (Seal)
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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.
5/6/20
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