HomeMy WebLinkAboutBuilding Permit Application 5 r o L �,✓
II APPLICABLE INFO MUST BE�OMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: `��vZ� Permit Number: 108
Al
L Luc! County Permitting
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division COm 'merCial Resid6ntial )
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: u Lot No.
Site Plan Name: (4 �P-QLY— Block No. 1 C�
Project Name: CA6 I-
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:-
-Mechanical GasTank.:- ' _Gas Piping _Shutters Windows/Doors _Pond
_Electric _Plumbing Sprinkles _Generator _-Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Z�C) Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name "'2 Name: w5��
Address: ITS w4 Company: i QCI�- 6-11N Lnl.S I.
City: }T . c_ R P L 'State: Address: :51 D( .VU cz� :1)2
Zip Code: Fax: City: Pc�72c-,L, Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail ELss 1/v,,y". 4
from the Owner listed above) State or County License Oc7�?
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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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
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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 Corrimencement 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 your1lptice of Comme t.
Signature of Owner/Lessee/Contractor as Agent for Owner Sig ture of - actor/Lie r
STATE OF FLORIDA STATE OF FLORIDA `4 L
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Swgfn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization P ysical Pre s nce r Online Notarization
this day of 12020 by this day of 202� by
Name of person making statement. Name of person ma ing statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of(dent" ion
Produced Produced
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida.)
Commission No. (Seal) Commission No. . VP'% KAREN SWPLSEN
4? tatate of flori a-Notary Public
+ Commission # GG 20' 4
June 12, 2 22
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE IVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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