HomeMy WebLinkAboutBuilding Permit Application SLAP)
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - .2 g ✓ .2 Permit Number: �I .?0
9``.LLUCE-
IY' 'F • . ._ n Building Permit Application
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
.PERMIT APPLICATION FOR: pq2 TV-
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Address: 6 t7A-Ar T CmLrk !'oeL.`S -V f;'re
Property Tax ID#: V Ot r -Q Lot No. !.2O
Site Plan Name: Block No.
Project Name: P,94i n S in-A
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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: �`O Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
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LLName D�1°i�� [� r321S �' � Name:
i
Address: $ �b12�1� ti C ' tz Company:
City: 196/1L4 Ail es Zi L State: FL, Address:
Zip Code: g5�• Fax: City: State:
Phone No. �'6 3 61 — 41611 Zip Code: Fax:
E-Mail: db eS S'rV 12 �� � - Cti lcal . /� 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.
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 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 t permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or nd covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your ed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree at I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. cie County Amendments.
The following building permit applications are exempt from undergoin full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen ro s and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice o Commencement may result in paying twice for
improvements to your property. A Notice of Co encement must be recorded in the public records of St.
Lucie County and posted on the jobsite before t e first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent f Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribe/20
me of _Physical Presence or Online Notarization
this day of by
Name of person making statement.
Personally Known OR Pr duced Identification
Type of Identification Produce
(Signature of Notary Publi State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21