HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED
Date: i (-7 1 Permit.Number-, 5 Qlli S
plication .
Planning and Development services
Building.and Code RegulationWislon Commercial Residential J
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2300 Virginia Avenue,Fort Pierce PL 34982
Phone:.(772)462-1553 Fax:(772)462-1578`
PERMIT APPLICATION FOR
PROPO► ED IiPRt}UEI�/INT,LQG # I
Address;
Property Tax ID 30\A k 1 d- Q0
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Site.Plan Name-, Block No..
Project Name: C n
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ctrical Me
ter
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Second.Electrical,Meter
CflNSTRE}CTIC}Ne1IVFOR;MATI;ON
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Additional work to be performed under this permit-check:all that apply: .
_Mechanical _Gas Tank Gas Piping. _Shuttefs _Windows/Doors Pond
_Electric _ Sprinklers _Generator i Roof Pitch
Total.Sq.Ft f Construction: Sq,.Ft.of First Floor: _
Cost of C ns_ 'ction:$ Utilities: —Sewer —Septic Building Height:
;OWNER ;
e m
,x CANT
Name Name:
Addres
Company:
City:.._ Statei_� Address:
Zip Code:. . Fax:
City: State:
Phone No Zip Code: Fax:
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mali
from the Owner listed above) State or County Lt ense.
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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SUPtt_ENjEtAt_COIST�ttlCTtal VZ
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:. Name:
Address: Address:
City:.. _ State: City:. State
Zip; Phone Zip: Phone:-
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: lNotApplicab(e
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 instal lation has commenced prior to the issuance of'a permit.
St.Lucie County makes no representation that isgranting a permit will:authorize the permit holder to build the subject structure.
which.is in conflict with any applicable Home Owners Association rules,byiaws.or and covenants that may restrict or prohibit such
structure.Please consult with yourrHome Owners Associatiowand review your deed for any restrictions which may apply.
In consideration;of the granting of this'requested'permit,l do:hereby agree that I wills in all respects,perform the work
in accordance with the approved plans;the Florida Building Codes.and:st.Lucie.County Amendments.
The followingbuilding..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.non4esidential ose
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 attorneybefore commencingwork or recordingour Notice of Commencement.
Agent for.Owner Signature of Contra or/License.Holder
Signature..of Owner Lessee ontr.c r as '
COUN°OF19_.FLORIDA
. __ STATE
o ®'�;d'DPli
Sw n to.(or.aff<rmed)and subscribed before me of Swn to(or,affirrded)'and subscribed before me of
V Physical Presence or' Online NoQtarization. yyVy Physical Presence or. . _ Online N tarization
this.Z day.of 202JLby this day of d 201 by
Name of p, rson making tateme w� tiu� lItA Name:of person making statement. \�ti►«ii«l�l�q
.`�N� G OMF ��ii �``�t1� GO M ijiji.
Personally Known 0 Personally Known OR P Jtt,
Type of.Identification :' * 9:` Type of Identification
140T P
Produced _ ..R Y a Produced ti 0 TA R y ,•;
t-�o Pus. _ PU.BLi
i 0O .. i ,
(Signature of Notary Public-S • ' OF �pP��` (Signature of Notary f�,Public-Sta �t ialaG ,,.•
Commission No. CommissionNo: 11181
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .
RECEIVED.
DATE
COMPLETED
Rev.
5/6/20
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