HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � l_��,
Date: Permit Number: 1 , J
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°" � -° � ` �• °~ ""' Building Permit Application DEC � � 2021
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Planning and Development Services St.Pecmiie.tt ou
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: y
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:aPROPOSED` IMP 0'1/ 'EDIT L®CA�TIO � ��,� r �•�-��� � y�;�� � ��'u ` k�,_�•• �; _�
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Address: �`� .� ��s�� �� �` - I—�- �3 `�J•%
Property Tax ID#: o�,n"co b 1 " b Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter y? 4
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CONSTRUCTION INFp05RsMATI:ON � F, R
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Additional workrto be performed under this permit—check all that apply:
VMechanical _Gas TankM1 _Gas Piping _Shutters r _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator -•Roof' Pitch
Total Sq. Ft of Constructio_n_:___ _L Sq. Ft. of First Floor:
Cost of Construction. !D o���� Utilities: —Sewer —Septic Building Height:
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Name - ..M.,�w,.>,«:..,�.�,.,.�....�.�,.,�...,� Name: - _,�,,.• �,>�..,,;...::�.,.,.�,,,.;,r
Address: �.�'L G°''Jr^,, �;,r;:: Company: a ,� o• r
7 CU�•t,('1^l::(ICifI::�_.. . v. " s • t'. _._'.�•; •• ;a;•.
City: ,. a•State:�� Address: / r% *h .
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Zip Code: ' '" •:2c>•�� :Fa - y: `°•�(��"-o+�aSTw sv.e..:r..o>.<r-.�acrs- t�Cit f ,,--J / F��•-� ; -
Phone No. all-3Zip Code:j Fax:
E-Mail: Phone No ?7Z — f 7 f- 7 7 3
Fill in fee simple Title Holder on next page(if different E-Mail ,r l/ _ %/F/ ./
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.
�JU�zPLEMENT�A -s-�T�I®N�LI,EN .IAUV IN °R� TI'
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLEtITLE HOLDER: 1�f -Not Applicable BONDING COMPANY: OS 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 Y rppr 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*ill;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 inten .to obtain financing, consult
with'lender or an orne before commencing work or recorgiVg your Not' e-of Commencement.
Si nature of O her/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR A STATE OF FLORIDA
COUNTY OF �'*U-)CAP- COUNTY OF �, �►7C-V�'
Sw rn to(or affirmed)and subscribed before me of Sw rn to(or affirmed) and subscribed before me of
Physical Pre ence or Online Notarization Physical Presence or Online Notarization
this day of 202Q by this day of 202i➢ by
Name of person making statement. Name of person making statement.
Personally Known *// OR Produced Identification Personally Known v OR Produced Identification
T e of Identification Type of Identification;,.,,,.,;n7
ro ced P ced -
ig A„ L .0 (Sig _
A, LALEE•CARTER
' =Commission;k HH 031802 :rat =Commission#HH 031802
Corn i '^y.��- , 024 (Se Com r� i p�ms epem r , 024 (S al)
C: •res A•
Bonded Tfw Ttoy Fain tnsurenw E00 3E5 701!! "'•FOF F4'•'• Bonded Thtu Tmy Fain lnsumnce SOW85d019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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