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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q� Date: bec, Permit Number:- — o© L • Building Permit Application Planning and Development Services j Building and Code Regulation Division Commercial Residential ,x r 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: ®_�Q. 1�-i (,y.Q�Au30045 Property Tax ID#: \.6 762 S 7,? Lot No. Site Plan Name: tir S Block No. Project Name: zdylf> /tv `,0/.� 711141,6z24 G ^ New Electrical Meter Second Electrical Meter (Affidavit required)NN ✓ Mo - -_ 3 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: T Name Address: lelly ,fe i' ~'G ':-Company ° ° 2 City: _Addrress: Zip Code: c(�Ls— Fax: City: �� P%e-,7 �.2 State: Phone No. - Zip Code:,3aC75-/ Fax: E-Mail: A Phone No � t7�2_, I C - � Fill in fee simple Title Holder on next page (if different E-Mail d 0- �4 /2- aAU4, - (Cold) from the Owner listed above) State or County License C C- I(.,q 3q I , 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. O 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 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 prohibit such 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 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 with lender or an attorney before commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Contr ctor as Agent for O sC�e_ STATE OF FLO �1� �¢ COUNTY OF Swor o(or affi ed) andsubscribed before me of Physical Presence or Online Notarization this day of 20_4j by 9,P A k "_bACA% in G Name of person making statement. Personally Known OR Produced Identification tification Produced n mu-_0 lzw�—��� 0 ( ignat of Notary Public-State o FI a_)_ ..��P YVETfE ELIZABETH PEPPARD Commission No. =?°' °� (Seal) ,*• *_ MY COMMISSION#HH000307 EXPIRES:August S,2024 FOP F��•' Bonded Thru Notary Public Underwiters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW- REVIEW DATE RECEIVED DATE COMPLETED Rev 5 Z 2 DESIGNER/ENGINEER: _Not Applicable7Ad AGE COMPANY: ^Not Applicable Name: 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 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 with lender or an attorney before commencjng work or recording our Notice of Commencement. Signature of Owner essee/Contractor es Agent for Owner STATE OF FLORIDA COUNTY OF Sworn to(or affirmed)and sub cribed befo e me of r hysical Presence or Online Notarization this day of 20by Name of person making statem nt. I Personally Known 4.1 OR Produced Iden ifi� ttion Type of Identification Produced L � � (Signature of Notary Public-State of Io ida) Commission ELLEN VAUGHN PY PU' State of Florida-Notary Pu is _. *= Commission # GG 270079 9, Q my Comrnl'ssion �xplres AA REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5, 0 2 I I i