HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: aEO Permit Number:
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.9 ,,•_ ..:tiff .•.-... BuilWeV&mit 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:
Address: CT03 Da�IV'1 r7 -1 Fw- P`
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Property Tax I D #: �% 2� _ Lot No. I
Site Plan Name: Block No. l ��
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Project Name:
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7
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New Electrical Meter Second Electrical Meter (Affidavit required)
110i Ma 3
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Sprinklers _ Generator _ Roof Pitch
Electric Plumbing sprinklers
_ _
Total Sq. Ft of Construction: 7t30 � Sq.' Ft. -of First Floor:
'
�- Cost of Construction: $ ! oo Utilities: _ Sewer _ Septic Building Height:
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Name
Name a. ; TCDC)
Address: .
.Company:
City: F-t l' w_cc-e- Stater
Addfess: 03 'Xivn pw
City_ - .q 1eSi _Cz Stater
Zip Code: ' 43 DE Fax:
Phone No. 11� ' �ag yQ3Lo
Zip Code:( Fax:
E-Mail: Q� 0_1� , CO�1
Phone No T11- S4''7 'y 0� (Q
Fill in fee sim a Title Holder on n`e4 page ( if different
E-Mail Cc- +
State or Coun y License
from the Owner listed above)
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.
ME! OWN
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MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _ 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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Signature of Owner/ Less ee/Contr ctor as gent for Owner
STATE OF FLORIDA
COUNTY OF S47}AJ eI f
� �-
Sworn to (or affirmed) and subscribed before me of v Physical Presence or Online Notarization
this day of d , 20Z4 by
Name of person making statement.
Personally Known OR Produced Inti� tion
Type of Identification Produced y(�
(Signature of Notary. ublic- S t f rida )
Commission No. (Seal) ��� �� HEATHER BURFORD
l vYh
?tate,of Florida Notary Public
. `
4-e�,
=*: commission # GG 1832157
s�5My Commission Expire
°�` February 06, 202=
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21
PLANNING & DEVELOPMENT SERVICES DEPARTMENT_
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
1, the undersigned, am the owner of the following described property,
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Property Owner Name (Please i t)
�Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF 5�_ kw: - _
ACKNOWLEDGED BEFORE ME THIS 7—(g DAY OF 120 ,
BY WHO IS PERSONALLY KNOWN TO NIE ❑ice OR WHO HAS
PRODUCED
SIG ATURE OF N TARY PUB
COMMISSION NUMBER
SLCPDSD Revised04/11/2011
AS IDENTIFICATION.
TYPE OR PRINT,NOTARY
(SEAL)
.,� HEATHER BURFORD
<<,s State of Florida -Notary Public
qP Commission # GG 183217
My Commission Expires
February 06, 2022
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