HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O
p Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:C
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Address: _✓l i I-XV LA
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Property Tax ID #: `tk" b(I - fI d` Q)'1C4 ° �`�y � 4 Lot No. 1161 g�
Site Plan Name: Block No. Y
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be perfgrmed 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:
` �}(� S ` au
Cost of Construction: $ "c� 1 Utilities: —Sewer _Septic
Building Height:
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TR'A,G OR
Name
Name: I
Address: .Y cLtk
Company:
City: Pr ,Y
Zip Code, rr; Fax:
Phone No.
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Address: `7.�
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City:
Zip Codo : Fax:
Phone No i
State: ,
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License CC
n 50
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLE"
` NTrPLCON$TRUCTIC;NtLfN LAW INMATIOIV
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consul t 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,
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,,oOn the jobsite before the first inspection. If you intend to obtain financing, consult
With Ipnripr nr an ettnrcfev befnre commencine work or recordine vour Notice of Commencement.
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Signature of G n ractor or- Owner Builder as applicable
STATE OF FLORY[Tl�
COUNTY OF �" .(
Swor o-(or affirrrrted) and subscribed before me of ¢'Physical Presence or Online Notarization
this day of 20by
"Cikyl In
Name of person making statement.
Personally Known __(L OR Produced Identification
T e offIIdentification Produc
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��l��F/.a _ _�)V 1 'k_Q 111�01 A
(Signature of Notary Public- State of Flori
;o)9"Y °Yoy. DANIF:LLE GONf,ALVC:u
Commission No. (Seal) N' liry .*; MV CGMMISSEOPJ#C3G 232448
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°j HonAeA 7hru Notu�Pubi llnd :rwrl'er�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21