HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLIC BBLLCEPP INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 4— T ,� 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:
Address: (
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���� — Lot No.
Property Tax ID #: l�
Site Plan Name: Block No.
C-=) C ty)
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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-_'110 011
[1* S&L_ I NaF RMT),®�i;
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Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Win ws/Doors _ Pond
'5//_
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: �ka S Sq. Ft. of First Floor:
Cost of Construction: $ 1 / l7 Utilities: —Sewer _Septic Building Height:
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Name
Name: 1-
Address: 'r��� ��
Company: '
Address: 60L 5t�) L
.
City A`5CtLA-f State
City: "t" State: 1�'
Zip Code: ?)A Gt SkL Fax:
Phone No. E-
Zip Code: —2)Qq�W -. Fax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail ice' I e -
State or Count icense OSW
from the Owner listed above)
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.
Name: _
Address:
City:
Zip:
INEER: _ Not Applica
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 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
utirh lnnrlbr nr nn attornev hPfnrP cnmmencing work or recordine vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA�
COUNTY OF -
Sworn t (or affirme )and subsc ribed before me of Physical Presence
or Online Notarization
thiv�k day of " e c 20,�H by
Name of p rson makin6werrient.
Personally Known OR Produced Identification
Type of Identification Produced —
(Signature of Notary Public- State of Florida) Kenny ,Hanzow
t
Commission No. (Seal) Notary Public
State of Florida
-
Comm# HH087667
s�NCE
AV
19� Expires 2/1/2025
REVIEWS FRONT ZONING SUPERVISOR PLANS
VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21