HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,b a Permit N tuber:
9 WOE
i
4 ,
RECEM_D
Building Permit Application OCT 0 021
Planning and Development Services St cie
Building and Code Regulation Division Commercial Residential mph
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:IQ
l/"-P— A �c1 �
Property Tax ID#: I `f t ( / $� y �, ri C-3 Lot No.
Site Plan Name: I Block No.
Project Name:
li !
o U
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 _Window /Doors ..Pond
_Electricumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
I.' 77
Cost of Construction: $ Utilities: —Sewer Septic Building Height:
Namele'I
Address: / 7 I•r S 1' Compsny;..._.-.- IQ
City: V? <-- '— State: Address: t�7 2JI S
i
Zip Code: le GZ Fax: City: v _ ! State:
Phone No. -E- Zip Code: 3 Y tS Fax: _
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail —-
from 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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: ' Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLtJlTLE,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 conflicts with any.applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 T OW R: our failure to Record a Notice of Commencement may result in paying twice for
improv en to ur property. A Notice of Commencement must be recorded in the public records of St.
Lucie un n osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with d or attorn efore commencingwork or recordingour Notice of Commencement.
tune of Owner/Lessee/Contractor as Agent for Owner
Sig
OF FLORIDA
COUNTY OF S-' -
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this _day of 1C 20W by
Vo bsLC-N ,t6t ( (0�
Name of person making statement.
Personally Known OR Pro�ced Identification
Type of Identification Produced L - ,
(Signature of Notary lipe' 'ik�e.of Flori
,=off Notary u Iic State of Florida
ommission it HH o86359
Commission No. o .Sfianomm.Expires Jan 28,2025
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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