HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(
Date: Permit Number: 0
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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: R N
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Address: 13 P19 Q L( (i M IFt. t— C o U vL t
Property Tax ID#: I Y l Lf - 7 D 1 0 1 (o t "' U OO/L Lot No.
Site Plan Name: �S�?�1�(-} L�(y 12 la L.-4 S !*-?'!/ Block No. 17
Project Name: I'll 5 n'L/ 12 LDS ( (,O l-tyC Lam'
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74 . L 0 c 1-a-h o"5 R S S 14 o IW tV c IV li d r-;e-H C S fz u L�i( To Lc�-� 5 l 1,.1=
New Electrical Meter Second Electrical Meter
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STRUCTI: a 011
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
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Total Sq. Ft of Construction: ,s, LF Sq. Ft. of First Floor:
Cost of,Construction:$ Utilities: —Sewer _Septic Building Height:
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Name (.�(v qA-t 4 Name:
Address: 5-t0RVZL l la2 t 0UV-t Company:
City: Foi- —Aa-z-La L-"' State:fl, Address:
Zip Code:349 c4 c1 Fax: City: State:
Phone No. (Q 3 0 - Zip Code: Fax:
E-Mail: Ste L•/SY'✓e' &MLk(L _e 9!!✓ Phone No
ill in fee simple Title Holder on next page(if different E-Mail
m 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.
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE F.91ST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND OR ATTORNEY BEFORE RECORDiII G YOUR NOTICE OF COMMENCEMENT."
Signat re 3POw er/Less /Contractor as Ag t for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,( COUNTY OF
The fQr�oing ins t w acknowledgeo,�before me The forgoing instrument was acknowledged before me
this r day o 20by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification 6� Type of Identification
Produced Produced
(Signature of Notary Public-State of (Signature of Notary Public-State of Florida )
ELLEN VAUGHN
Cornmissio ��RYP�i/, rida N� )Public (Seal)
Commission No.
*= Commission # GG 27007
u C ommission Expires,
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REVIEWS SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
.COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
(DATE
RECEIVED
DATE
,COMPLETED F_
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