HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virainia Avenue, Fort Pierce FL 34982
-21 /6
Permit Number. RFrFIVFn
OCT 2 7 2021
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Building Permit Application Permlttln
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT Hrfru-.
A�lP�PItRL.!I1CATION FOR: ko
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Address: I
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Y" D 2 ' 0 % " DOD D, Lot No. �
Property Tax' ID #: L7
Site Plan Name: WM 6 S Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
•CQNSTRUCTtON
IN�OI�MATI�?f'� v �
Additional work to be performed under this permit —check ail that apply:
✓ Mechanical Gms Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
v Electric = Plumbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r'nct of rnnctriirtinn• Itk�ol 0 Iitilitiar. ✓Sewer Sentic Building Height: L
Name i5
Name:
Address: Ot
Company:
City: 11?±Anrmtm State: _
Address:
Zip Code: Fax:
City: C-W>LA
State:
Phone No. E-
Zip Code: 34111Flax::
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4
Mail:
Phone No Sk
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Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License7ST,—��.
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC Is 57.500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
ANTI. a/.1-o•r%wanwwly. KI-4-
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Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Citv_
Zip: Phone:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inaicatea.
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
str uctur a please cons! I!t with vnlir Hnmenwners 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
IAj^rL .%r rcrni-Aina ynrir Nntira of rnmmp_ ricement.
W llll IGI IYGI VI Gill VGGVIII\.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF I AAX' n 1i J
y
Sworn to (or affirmed) an ubscllri��be__d''b++e a me of
Physical "Presence or %JI IIII IG IIYVtUI,MQUSUII
this day of 20 by
C] +y t/l' C yu / UNw✓(
-
Name of person making statement.
Q
` OR Produced Identification
Personally Known
7E'Wp,6f1ZPeqtification Produced
(Signature of Notary P ic- State of Florida)
Commission No. (Seal) Notary Public Stine of Flonds
NANCY MIMS ARMSTONG
My Commission GG
Expir09/18/M 913313
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
StA I UKI Lt
IVIAIvGKUvE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21