HomeMy WebLinkAboutBuilding Permit Application I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-\ 131 a.\ Permit Number:
Z:EIDED
21r.L'UC E -K;� NOV 0 3 20
21
' St.Lucie.County
Building Permit Application Per
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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 CBDG Funding
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PERMIT APPLICATION FOR: -- , __ . .___
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PROPOSED:IMPROVEMENT LOCATION: ( j
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Address: yk 3(p lea}co- «C .�1ca.(
Property Tax ID#: 2_S�Z-5C,D-pyIL(-=C0Q-1 Lot No.
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Site Plan Name: ! Block No.
Project Name:
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DETAILED DESCRIPTION OF WORK: = .
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New Electrical Meter_Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ?cc Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:- CONTRACTOR,:
Name PIRj-14 Jvggv-C�r_5Ar<,`- Name:
Address: 3 SLf Ul Company:
City: - (4lv� 8ca - ar c ,Ai C State: Address: Azo y' yA,rk-_-
-Zip Code: 3 % Fax: City:_VTt-'Sst lute State: FL_
Phone IVo. E- Zip Code: 1- 14W i53 Fax:
Mail: Phone No `-7*72- SZV -2tZq
Fill in fee simple title Holder on next page Of different E-MaiL yb-car__c\ecwiC CC-_l{ia��cs:�__Css ___.J__`
from the Owner listed above) State or County License 3Gp,r f,
if value of construction is 2900 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7500 or more;a RECORDED Notice of Commencement is required:
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'I MbCTION LIEN LAW tNFORMATIQN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: —Not Applicable
Name:----------------- -----____ Name:
Address: Address:
City: State: City: I 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 woik 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 Ibuild.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 restriction's 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 att6rh0 before t6ffim bn effig Work or-recording--our Notice of Comrinencement.
Signature f owner/L see/Contractor as Agent for Owner
STATE OF 41OTPr4
COUNTY OF -Lo-C-I-15__—,_ --
Sworn to�I (-or affirm d)and subscribed before me of Physical Presence or Online Notarization
this `?r�dayof V 202.1 by I
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Name of person making statement. /
Personally Known OR Produced Identification
Ty Identification Produced i'L D L- ,
(Signature of Notary Public-State of Florida)
H yl�D SIMEON MILLER
Commission No. (Seal) °t Notary Public
zz State of Florida
A ' '= Comm#HH174180
El Expires 9/9/2025
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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