HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
N Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: N V�� — rqo(�2���Y1 �� iye fo_- I ( k
vi�"'r ' ... k
jj(�G IrT L?CAT1N
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Address: U C W
n Property Tax ID #: OG 2-GOC - Lot No.
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Site Plan Name: Block No.
Project Name: Ln I I n -
ON OF WORK.
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R�Ilettr 541on5 ��2
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit — check all that apply:
AMechanical Gas Tank —Gas Piping _ Shutters —Windows/Doors _ Pond
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $y L Utilities: —Sewer —Septic Building Height:
ajiT ACT TI
Name I I'1 Name
Address:70iqA at4 Company
city: �6 V+ k �l t CZ State: � Address: 5 V
Zip Code: Fax qQ City: Stater
Phone No. Zip Code: Fax"?�Z�3 `tt-�"%?��%
E-Mail: QIL S� ll_W� Phone No _72- __W� - ��
Fill in fee s mple Title Holder on n "t page ( if different E-Mail S 61Ai'1
from the Owner listed above) State or qounty License
i
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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ae s n
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
__ __ _.� _. .. r1 c,. ,, ,,. ,�., .,�, ,.,nrh nr rnrnMina vnur Nntire of Commencement.
with lender or an aLLor ne lie gi a cui i n nel ldl
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Si f Owreer Lessee/Contractor as Agent for Owner
na ,"Cont ac or/License Holder
L
STATE OF FLORIDA��
TATE OF FLORID
COUNTY OF I �fp 1 P
COUNTY OF �t ca
Swor to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
VPhysical Presence or Online Notarization
J_V4 202 1 by
Physical Presence or Online Notarization
this Ad day of T Y� _. 202 � by
this day of if
Name of person making statement.
Name of person mak^ing/statement.
Personally Known v OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Publi (Signature of Notary Publi
��' Notary Public Stall Of Fonds �` NOtary Public State of Fonda
Cra�te�p A�G�,rrossman Cra�g, @� ossman
Commission No. My�MdIIW GG 983069 ommission No. My Commilsion GG 98a069
Eroms 05/10/2024 Expires 05/10/2024
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU