HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date. Permit Number.acDt1
RECEIVED
�, r JAN 2 5 2021
a _,.:� .,• DM��...M. Building Permit Application
St.ti
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Planning and Development Services ng
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:
75
Address:`
Property Tax ID#: S U_� U 0?0 �� U `� Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
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Name Lo rT r c -L f t Name
Address: 5'-77 MA l C� c �1S Company:
City: o N LAW 2PI7 State: C12In0,4Address: l-7-L S �' 6-
Zip Code: Fax: City: State: I`
Phone No. b� �� C�Z 3 13� Zip Co e: .Z 7` n/�y Fax:
E-Mail: ' Phone No -72 2 '2d
Fill in fee simple Title Holder on next page (if different E-Mai --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.
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 Fplications are exempt from undergoing a full concurrency review:room additions,
accessory structures,s imryr�ng pools, fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO O ER':Your failure to Record a Notice of Commencement may result in paying twice for
improveme s o you ropert Notice of Commencement must be recorded in the public records of St.
Lucie Co u �i dY";ted oll/t bsite before the first inspection. If you intend to obtain financing, consult
with len 4 r roanorne //bb o e commencing work or recording our Notice of Commencement.
Signature 0 er/Lessee/Contractor as Agent for Owner
STATAF FLORIDA
COUNTY OF
Swop (or affirm d) and subscribed before me of _Physical Presence or Online Notarization
thi day of 207��E)Cy
Name of person making state ent. /
Personally Known OR Produ Ide qfication
Type of Identifi ation Pr ced
(Signature of Notary Public-State of Florida
KAREN S. NIELSEN
;owg',��
°Prv� State of Florida-Notary Public
Commission No. (Seal) _ �;
_• *= Commission # GG 207484
'9 My Cornrnission Expires
`Of`� June 12, 2022
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DATE
RECEIVED
DATE
COMPLETED
Rev 5 21