HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ff��
Date: Permit Number:
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Building Permit Applicatil{p,Qe�rent
Planning and Development Services PerSt. ucle County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential (—
PERMITTYPE:
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Property Tax ID#: oZ Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to ed under this permit—check all that apply:
_Mechanical ,Gas Tank Gas Piping _Shutters Windows/Doors
_Electric —Plumbing ^Sprin s i Generator .—Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. irst Floor:
C70
Cost of Construction: $ Utilities: _Sewer _ eptic Building Height:
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Name � Name:
Address: I Ok Qf,=2 � ,�)�� r-6 Company:
City: F �. State:, Address:
Zip Code: Fax: City: State:
Phone No.�� -3 � ga—�{��� Zip Code: Fax:'
E-Mail: - , Phone No
Fill in fee simp a Title Holder on next page( if different N E-Mail
from the Owner listed above) � nn r.(�p tate or County License
If value of construction is$2500 or more,a RECO ED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED o ice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: tate: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: e:
Address: 7AS s:
City: ty:
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENPW Q.R AN ATTORDIEY, BEFORE RECORDiNG YOUR NOTICE OF COMMENCEMENT."
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Signature of oven 19r,Ifessee/Contrac o a Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF 'cy -2, COUNTY OF
The forgoing instrument was acknowled before me The forgoing instrument was acknowledged before me
thi�4day of 2 _ by this of 20_ by
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L-!Q' g\Pe)&W v,
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 V Produced
(Signature of N ac k4,c-Stat lBlriMAPGHN (Signature of Notary Public-State of Florida )
_r `�State of Florida-Notary Public
_• *_ commissionJ G,9 270079 Commission No. (Seal
Commission No ommi i Expires
October 22 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.