HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPUCABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` r�
Date: Z� ��.� Permit Number:
ci�,o LOM , RECEIVED
° , •:� Building Permit Application PEC 17 2021
Planning and Development Services St.Lucie Cnu
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:
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Address: ,516 12� T�-
Property Tax I D.#: IS I A-S 0 a-', a 0 7- ODD 3 Lot No. 9 s
Site Plan Name: L, uvn T" " S �% 50 , rr� Block No.
Project Name: N
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New Electrical Meter Second Electrical Meter
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Additional work to-be performed under this permit-check all'that apply:
_Mechanical Gas Tank ' 1"- Gas Piping Shutters _Windows/Doors —Pond
Electric _Plumbing' ' _Sprinklers r Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 3 �� 0 v Utilities: _Sewer _Septic Building Height:
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Name Dina _ rn Sw Name: / "e
Address: be t r Company: CQAA/ #0k) AS It,9
City: ,-2 f-c 2 State: EL Address: 4.2 36 d. Lest;
Zip Code: 3 q l Fax: City: let. Stater
Phone No.A 6 Z- 53 7 7s03 Zip Code: 3 U 9 y6 Fax:7 2?-W 1-iOZZ
E-Mail: Al 1A Phone No?V-
Fill in fee simple Tdie Holder on next page If different E-Mail 7-orn. Ir"j,G Q y�aw, cow
from the Owner listed above) State or County License se e jai/s1.9"0 e
If value of construction is 25W 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/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 covenantsthat 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,wails,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 attornev before commencing work or recording Notice f Commencement.
na re of Owner/Lesse /Contractor as Agent for Owner Signature of Can actor/License Holder
STATE OF FLORID4k I STATE OF FLORID��
COUNTY OF ��� COUNTY OF
Sworn or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of
_LZPhysical Presence or Online Notarization Physical Presence or Online Notarization
this t 3 day of WCO ,2M by this day of 2Z by
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification v
Type of Identification Type of Identification `
Prod laU•IPA D"»ha_ �ied tv Produce lcu.� QU.Wt W . L(C_ + e
gnature of No - of Florid ( ature of.Notary P c- to of ida) �Ptiav ��aa
�+ ORIANDQVAZQu� NOD SCate°E �1
Commission No. �Fr l�S :7. N se��pl"-�t iesea1 Commission No. 'mil �scls (S
a s Commission b26,2o22 ;:F"vuei�.`-. N CoR`R' tixP�� atN°Zaty
MY Comm.Expires Fe CoR`� Na��On
'.'ff _-or•` al Notary
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REVIEWS FRONT I G SUPERVISOR PLANS VEGETATION SE Tl "L ' ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW R REVIEW
DATE
RECEIVED
DATE
COMPLETED
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