HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91� (Lill 9R
P : ' -•T ,,� Building Permit Application
RECEIV
Planning and Development Services
Building and Code Regulation Division Commercial _ Residential
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 A.Lucie County
Permitting
PERMIT APPLICATION FOR:
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Address: �� tPc�t, A If4ots 'l L f-v-1
Property Tax ID#: ���C' �� l '��i�'�OI w Lot No.
Site Plan Name: Block No.
Project Name:
. - MEM
an
New Electrical Meter Second Electrical Meter (Affidavit required)
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 �oof Pitch
Total Sq. Ft of Construction: l C) Sq. Ft. of First Floor:
Cost of Construction: $ O a m Utilities: _Sewer _Septic Building Height:
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-Name Name:
Addr Company:
City. Address:
Zip Code: _3 Fax: City: State:
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Phone No—nZ- - Zip Code: Fax:
E-Mail GCe_D. WC-AVE.J-;70 r Phone No
Fill in ee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
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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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M!mill;
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 p n the jobsite before the first inspection. If you intend to obtain financing, consult
der or an t r ey before commencing work or recording our Notice of Commencement.
Signa e of wner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY CIF_ ��' �c
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this_day of 20_ by
Name of person 4aking statement. \
Personally Known OR Produced Identification _
J( n9utrre
of Identification Produced CL�1-.
of Notary Public State,ti1f Florida) {NAINGRAM-RAt WW
riA` P #GG 276M
Commission No. (Seal) �� EVI p 20.2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21