HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J /�
Date: Permit Number: � I V
o r
Building Permit Application o loll
Planning and Development Services SEP 2
Building and Code Regulation Division Commercial Reside Oak oe rtment
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie
Phone: (772) 462-1553 Fax: (772).462-1578 CBDG. Funding
PERMIT APPLICATION FOR: -
emo
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Address:
Property
Site Plan Name:
Project Name: _
New Ele
i ivieter
Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ Zia
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Block No.
_ Pond
_ Pitch
Building Height:
tCiiVNEtlSSEE x� .'ONE
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Name N 12 to
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Name: !�%�i�►r ��,�,�,d A;-e-
Address: y%D lio,f�cl and -
Company;'
City: � ,�i[�rtt State: "'FL
Zip Code: Fax: - `
Phone No. E-
Address`. ` :�/ ib Golecbw rcL
City} ,�.`Qrc� State: �i :
Zip Code: S% Fax:
Phone No 7%o?' 7DX`/24
//7%Z_,6r/%�y
Mail"/
Fill in fee simple Title Holder on ext page (if different
from the Owner listed above)
E-Mail
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:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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'l;Iuild 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 a'n'd,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 attornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ L ontractor nt for Owner
STATE OF FLORIDA
� �� �
COUNTY OF ,Sir . L�t�[,a e
Sworn to (or affirmed) and subscribed before me of op" Physical Presence or Online Notarization
this dn day of 20;t by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced 1X�
AA
(Signature of Notary Public- State of Flori III
Commission'No. (Seal)
HEATHER BURfO'RD
;a5�OaYP`6A State of Florida -Notary Public _
5. +_ Commission # GG 183217"
%9 oQd� My Commission Expires
February 06, 2022
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SUPERVISOR PLANS VEGETATION, SEATURTLE- MANGROVE
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DATE
RECEIVED .
DATE
COMPLETED
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