HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2� Permit Number: ®
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Planning and Development Services
Building and Code Regulation Division - Commercial Residential 1/4AI3038
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: ON
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Address: � Y
Property Tax ID#: tl , I Lot No. Z
Site.Plan Name: NOY S Block No.
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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:
Name Name:
Addres Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone No. — E- Zip Code: Fax-
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Mail Phone No
Fill ir4.f a si I Title der on next page (if different E-Mail
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from the Owner listed above) State o oun y i ense
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 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,
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
wj h le d o r or an aAtQoney bef re commencing work or recording our Notice of Commencement.
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SignVE
re of Contractor- -0 er Bu der as applicable
STA OF FLORID li��
COUNTY OF li
Swore(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this_j5_day of MAQ1,02 ,20aa�
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Name of person making statement.
Personally Known OR Produced Identifica ion I 1
Type of Identification Produced�eV0 I I v e r S .e ,
(Signature of Notary P lic-State of Florida) ���� z
Commission No. (Seal)Seal oipfl°e <,';^ AUDREY E.HUIMPHREY
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* MY COMMISSION I GG 300817
�•, "'``-�`°` EXPIRES:^larch 6,2023
8ondcd Thru Notary Public Jndenvriterc {I I;y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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