HomeMy WebLinkAboutBuilding Permit Applicationr'
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I a n
Date: QL. a J •a\ Permit Number:
------------
RECEIVED
• - -
FEB 2 3 2021
Buolding Permit Application
Permitting men+
Planning and Development Services
St, Luciea CCounounty
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:��
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Address: W/19
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Lot No.
Property Tax ID #: "1 ,0 v�
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Site Plan Name:
Block No.
Project Name:
Additional work to be performed under this permit- check all that apply: '
Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers —Generator . _ Roof Pitch
Total Sq. Ft of Construction': �_�� -iX Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
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Name :�
Name:
Address: _ �'�1��P
Company:
City: 4 fi��%CLCi� State:
Zip Code: •u✓�r Fax: ',,
Phone No. (,� ' ��
Address:
City,: State:
Zip,Code: Fax:
Phone No
E-Mail: 6,--. Lefiil
Fill in fee simple Title 'Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is .�)2Suu or more, a ntLvrcucu IMULI« U l.,-}—,- If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINIEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .DOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
wwvrFul VraUa- SkJng% rnO AEU ATT.nPR=V 9:tg:r_nvF PFrnpnilimr. YOUR NOTICE OF COMMENCEMENT."
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Signatur of Owner/ Less e/Contracto for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �
STATE OF FLORIDA
COUNTY OF �Cl
COUNTY OF
The r ing instru was acknowledged before me
The forgoing instrument was acknowledged before me
day 20_ by
tI ay of _, 20& by
tnw,k_ r� N�nt��1Name
this _ of
of person making statemName
of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identif-e�
Type of Identification_
Produced
Produced
AA
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. `a'r"d''o KAREN �SWELSEN
Commission No. (Seal)
_ �; fate of Florida -Notary Public
*_ Commission # GG 207484
REVIEWS
sion
June 2, 2
xpires
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DATE
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DATE
COMPLETED
ev. 2/7/19