HomeMy WebLinkAboutBuilding Permit Application I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i (`�— �J`21 1 Permit Number: a` r'I o �
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Building Permit Application
lanning 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
PERMIT APPLICATION FOR:
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. •5E�t3 'P fJ ._ T O Al'ttJ�
Address: a u e,YioC1t(l ` t �►rCU -FL, -3-/4Q FcQ
: ,
Property Tax ID#: `�� L �7�- Lot No.
Site Plan Name: Block No.
Project Name:
► �Tt'LED � �R�1" 1i+3 � WflRK`
Q Ovc qwund c-
, nq O. 06
Ni w Electrical Meter= Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit—check all that apply:
_Me nical _Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: I Sq. Ft.of First Floor:
Ci st of Construction:$ I�� - ® � Utilities: _Sewer _Septic Building Height:
EM, NA
TR:
Name QYJy1c) CILV Name:
IAlddress:30�L4'I V on 5-�- Company:
Cit State:9L Address:
Zip Code: 3CACL g Fa City: State:
Phone No.
FJ�S� �J C[ E- Zip Code: Fax:
Mail:_�O�C�Y►® 52l l m Phone No
Fill in fee simple Title Holder'on next page (if different E-Mail _
from the Owner listed above) State or County License
Ifvalue 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.
5 P E�MEN1'AL Gf3NSTR GTIUN EN LAW 1 FC} aMATIN;
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 install on has commenced prior to the issuance of a permit.
St. Lucie County makes no re esentation that is granting a permit will authorize the permit h Ider to build the subject structure
which conflicts with any applic1le Homeowners Association rules,bylaws or and covenants hat may restrict or prohibit such
structure.Please consult with y r Homeowners Association and review your deed for any/restrictions which may apply.
Inconsideration of the granting oft ' requested permit, I do hereby agree that I will ' all respects,perform the work
in accordance with the approved plans, he Florida Building Codes and St. Lucie Co ty Amendments.
The following building permit applications exempt from undergoing a full ncurrency review: room additions,
accessory structures,swimming pools,fences, ails,signs,screen rooms d accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Reco a Notice of C mencement may result in paying twice for
improvements to your property, A Notice f Com ncement must be recorded in the public records of St.
Lucie County and posted on the jobsite befdN th first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencin ork or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Age n or Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscri d before me of Physical Presen or Online Notarization
this day of 20_by
Name of person makin atement.
Personally Known OR Produced Identification
Type of Identification Produced t
(Signature of Notary Public-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Ad d ress: 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.
l 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 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 der or an attorney before commencing work or recording our Notice of Commencement.
I
ignature of Owner/Lessee/Contractoro Agent for Owner
STATE OF FLORIDA r
COUNTY OFF
Sworn o(or affirmed)an subscribed before me of Physical Presence or Online Notarization
this 1 day of AW 20i by
K=fv VG Cif
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of F orida)
Commission No. Seal ELLEN
VAUGHN
==a Public
tate of Florida-Notary
¢= Eorn lissior, #GG 270079
=N - Expires
icy com etf 22 2022
6tOb� 22
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev