HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMl4 'iD FOR APPLICATION TO BE ACCEPTED
Date:
I0 - 2� - Z Permit Number: / U
g-CEIV
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Department
BuHding Permit Application PermitSt.ting ountY
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Id PERMIT APPLICATION FOR: iuxitoshw
Address:
II( MV- -J
Property Tax ID #: /10 7�9
Site Plan Name:
Project Name:
Lot No._
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required) v
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Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total So. Ft of Construction: 14
i
Cost of Construction: $ L
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
3 Co' co Utilities: —Sewer _Septic Building Height:
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Name
Name: D n) --JA'"a S
Address:
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Company: W,—cw e)
City:erce,Stat
Zip Code: Fax:
Phone No.a
Address: %O1 01N C/
.City: State-/,—,C--
Zip Codd:Fax: �i
Phone No -7% 4-1c;' 7 O
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 1�� c.W. el.-t2s/ 9 f� �' �W
State or County License t�dz a
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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yMORTGAGE
DESIGNER/ENGINEER: _ Not Applicable 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- authorise th'e 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 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signa of Owner/ L s ee/Contractor as Agent for Owner
STA OF FLORID
COUNTY OF LL,ri
Sworn tp (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of OCtObar 20 a) by
o h ►� 7-50'co %s
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of N ry(P�ublic- State of Flori )
Commission No. G O (Seal) v vi,, Notary Public State of Florida
,
�' Casey•Binkley • ; , . ', _
My Commission GG 908880
Expires 0812212023
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DATE
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Rev 5 20 21