HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /"��J �O a� o Permit Number: '
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B �di gromit Application
Planning and Development Services
Building and Code Regulation Division. Commercial Resld-efltlal
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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^ __ Sib s o�/ Lam, �-�
Address:
Property Tax ID#: �� ►�500' nl oo� Lot No.
Site Plan Name: Block No.
Project Name:
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: $ 35L)(7 —" Utilities: —Sewer _Septic Building Height:
Name N'; ;_;; t ar" Name: -�
Address: �'D' Company:
City: cn � State:_ Address:
Zip Code: Fax: City: State
Phone No. 77� �7C7 E- Zip Code: 3 Y 7 Fax:
IVlail: Phone No 77
Fill in fee simple Title Holder on next page (if different E-Mail Avt � l�
from the Owner listed above) State or County Lic nse
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.
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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 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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,
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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 t our property. A Notice of Commencement must be recorded in the public records of St.
Lucie Count po.ted on the jobsite before the first inspection. If you intend to obtain financing, consult
with le r q n a orne before commencing work or recording our Notice of Commencement.
Signatu C tractor-or-Owner Builder as applicable
STATE FLORID t
COIJ OF .►�,i.r��� \
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this_day of 20_by
Name of person making stat ent.
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Personally Known OR Produced Identification
Type of d tification Produced
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(Si atur of otary Public-State of rida) ;,+;s'v,';'i IASHAHNAINGRAM•RAHMING
My COMMISSION�GO 275060
Commission No. (Seal} P�F I:XPIRES:pBcembpt20,2022
BOrlded Thtu Nota1Y QUbtic U( YfB
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW I REVIEW REVIEW
DATE
RECEIVED `
DATE
COMPLETED
Rev 10/12/21