HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED c
Date: Permit Number:
-
'' 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:
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Address: �.00p �•/l SuJd Cnt i tStne_ /%wl, 3 �g�
Property Tax ID#: D ~d OV Lot No.
Site Plan Name: Block No.
Project Name A41ja
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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: ' 'Sq.-Ft of First Floor:
Cost of Construction:$_ ���' Utilities: . -_Sewer': _<, Septic ''=Building Height:
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Name b h K nn 1 Name: �! '
Address: tab 6 C.-i SW odl 14^-r— Company:
City: CX4 State: . Address: rX
Zip Code: 3LK?oJL Fax: City: State:
Phone No. E- Zip Code: Fax:
Mail: SY'4 di e P 0 ct KOO- evry', 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.
MIMA
MIN
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 installation has commenced prior to the issuance of a permit.
St. Lucie County makes noTepresentation 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 restrictor prohibit such
structure. Please consult with your Homeowriers:Association and.reviewyour 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 p sted n the jobsite before the first_inspection. If you intend to obtain financing, consult
with lender an �tor before commencing work.or recording our Notice of Commencement.-'.
Signature o Owner/Less ee/itAtractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn (or affir and subscribed bef r me of IoPhysical Presence or Online Notarization
this •�day of 20��by
Sohn JrY�
Name of person making statement.
Personally Known OR Produced Identification L/
Type of Identification Produced
(Signature of Notary Public-Sta
`lP1FIY PUB ELLEN VAUGHN
Commission No. �T;state of Florida-Notary Public
:€ Gofrirtii�si6n # GG 270079
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10
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION: SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW -REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 20 2