HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 ' eJ - v)-I Permit Number: Q .a
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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 CBDG Funding
PERMIT APPLICATION FOR: beoo, KLAe-w S-
Address: AJ 8 6b Oaf (
Property Tax ID #: 143 3 11 -
Site Plan Name: 1 e- 1 t
Project Name: ') C61
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New Electrical Mete Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank —Gas Piping _ Shutters ^ Windows/Doors _ Pond:
_fictric ✓ Plumbing Sprinklers Generator Roof Pitch
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Total Sq. Ft of Construction: / 1 �nn (S� Sq. Ft. of First Floor:
Cost of Construction: $ 15C',00 Utilities: —Sewer _ Septic Building Height:
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Name t!%S
Name: M12 0 uJog-r- w5
Address: 60 Q, allZ4s
Company:
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City: f rC'q. State: �L
Address:
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Zip Code:3 L(9 ' % Fax: i31705
City: State:
Phone iNo. 5 - T6 qb E-
Zip Code: Fax:
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Mail: uJ5. eCi. CL-;) rAca L, 4
Phone No
Fill in fee simple Title Holder on dxt page (if different
E-Mail
State or County License
from the Owner listed above)
It 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 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.
1 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 1 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 vour Notice of Commencement.
Signature of wnerl Lessee/Contractor as Agent for Owner
STATE OF I LO
COUNTY OF
Sw (or a r be b e e of Physical Presence or
Online Notarization
this o 2iy
Name of person making stat ent.
; 4 pu`•.;
KRISTINE HOPKINS
(:
Notary Public • State of Florida
Personally Known OR Produced I ification®�?`
"
Commission p HH 073152
Type of Identifica i rod
°F
My Comm. Expires Jan 25, 2025
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
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