HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial L' Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
TION:
Address: ����-� Dano kA
Property Tax ID#: 'J^��'�lLot No.
Site Plan Name: '' II Block No.
Project Name: - �f" — u nn — I pc � KI D641
New Electrical Meter Second Electrical Meter
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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: Sq. Ft. of First Floor:
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Cost of Construction: $ l� 3 Utilities: _ Sewer _ Septic Building Height:
Name " C tact
Addres
City: � /IState..
Zip Code: Fax: 77"�'1
Phone No. C
Fill in fe'dsimple Title Holder on next page ( if different
from the Owner listed above)
Name: \Jf-`-t�ell \! ( Y �YI 1 Gc d ! r
Company: Sl MC1-7M.
Addres :
City: State:
Zip Code: Z Fax:772- e---'/'70
Phone No 7
E-Mail 6 r-) 04 C' , n e-4-
State or &unty License eAA L��7 2AF-1 cj
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.
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
BONDING COMPANY: 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.
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Si f Owr er Lessee/Contractor as Agent for Owner
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na 4iy ' 'Cont ac or/License Holder
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STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF�� I Ltc-e
COUNTY OF Lo 6,e
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this �'�(day of W ri I2021 by
Sw� to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of III 2022 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 Publi
Notary Pubbc Stall of Fonds
Cr .p A'1���roaaman
Commission No. MyIs.wnGG983089
a M1d� Expires 05/1012024
(Signature of Notary Publi
col" "tl� NOUry Pubhc State d Flonda
ommission No. Cra(�@�bTossman
j� MAY ommi4sion GG 963069
• .,�Rd� Expires 0511012024
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.