HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 9-2-21 t. l
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: a a Permit Number:QAO`\'Od1�
Building Permit Application
Planning and Development Services
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR-
-PROPOSED IMPROVEMENT LOCATION:
Address: 8�98 SOi Cebus h :Q:q rr0 CR- q5a
Property Tax ID#:3L4o'p a--I b3- OOgy- 006- O Lot No.
Site Plan Name: Block No.
Project Name:
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DETAILED DESCRIPTION OF WORK; I
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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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 _Ro I of Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ /0 000 . — Utilities: —Sewer _Septic iuilding Height:
OWNER/LESSEE: CONTRACTQR:
Namey�)Oylyl0. 1z,o(I Name:00.<e CrOV►chl
Address:$a►g 8 S59I e:ht�S1n I,-fYrGG-C Company: 5-rc- conc '�-- Plus
City: AS L _State:I-Lr Address: 9"1 R) &ICr6l nalr N4 C.QIncx l
Zip Code:&q 5 a Fax: N I R City: Vbl. I State: 47L-
Phone No. 7-M T7q -31 a 3 E- Zip Code: 3 Li q 9_1 I Fax: N I R
Mail:_&/ 14 Phone No-1'12'2110' 1�>y W
Fill in fee simple Title Holder on next page(if different E-Mail,NfiC,• Cn V1CY--e-k.CADS (53 OD LW W ryl
from the Owner listed above) State or County License9 r
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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DESIGNER/ENG(NEER: Not Applicable MORTGAGE COMPANY: Not Applicable -
Name: Name:
Address: Address;
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 'Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 grantin 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 consu t 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 Coun d ,osted on the jobsite before the first inspection. If you intend to obtain financing,consult
with lend n
or attorne before commencing work or recording our Notice of Commencement.
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Signatu of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S-k%
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this%N day of Sstq:r .20 B4 by
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Name of person making statement. -
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Not i ate of FWdo GIVENS
�n�s..
Notary Public State of Florida
Commission No. pp�assion Y KH 086359
aFFo-:: � Expires Jan 28,2025
Bonded through National Notary Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 512-011-1
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