HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: C?1 f`j
-031 1
S LUCE
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:
Address: �� S l.¢1`Q2tj (,. /✓�-,
Property Tax ID
Site Plan Name:
Project Name: _
New Electrical Meter 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
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 0
Lot No.
Block No.
Liz)
Sq. Ft'. of First Floor:
Utilities: _Sewer _Septic Building Height:
Pond
Pitch
..
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Name ���=
Address: J';�%%a :''<'}�,, ,} .,1 ; '
Name: �t r�
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Company:
O'-G11.
City: .. ' a �s: ,<T�. ' .., :<<State:
Zip Code: �.%` Fax:
Phone No. l�"�L�� °' �� / '"� r% %
Address: <ro . �*e?
City:
Zip Code: ;3 7
Phone No
State:
Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 7 e_
1 ,6/17
State or County License
d 9 g 16A
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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St»ii � IYIENIAL N�Ti� 1 ` l 'W�3
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DESIGNER/ENGINEER: _Not Applicable
MORTGAGf NY: � _Not Applicable
Name:
Name: -
Address:
Addr s: 0
City: State:
City: -.Q,6 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 installation has commenced prior to the issuance of a permit.
St. Lucien makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or such
prohibit
structure. Please consult with your Home Owners 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 l will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and Si. 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 attorney before commencing work or recording our Notice'of Commencement.
Signature ner/ Lessee/Con a or -as Agent Ti?bt7
STATE OF FLORIDA c
COUNTY OF
�Y J
Sworn Ko (or affirmed) and subscribed before me of Physical Presence or Online Notarization
K1
this day of 2(A'-a by
Name of person making,statertYent.
\'
Personally Known OR Produced Identification
T of Identification Produced OJT
75igriature of Notary Publi . State of FI'orida )
Commission No. (Seal) # ^ .LASHAHNAINGRAd1•RAUNG
MY COMMISSION O GG 2i'M
_�. EXPIRES: December20, 2022
Bonded71ruNotaryPubfoUn&mft rs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21