HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a .S7
Date: Permit Number: G'C.CJ
g Building Permit Application
Planning and Development services
lttin9 Depar��t�''`
perR�t Luc„r�o��r"'
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:
Address:l G �`�'t� Ulil� RU rrF�R� PiG�f �rL auqt4`�
Property Tax ID#: �7Sf0 — yf Szs�—Ay I V 133 .2, owtk
Site Plan Name: Block No.
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:
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439c.'st�
Name Y SiNt� Sias. Name:
Address: Company:
City:—�yzs $i State:'Fi- Address:
Zip Coder Fax: City: State:
Phone No. !9 Q2 3eo 3 CaO191i E- Zip Code: Fax:
Mail: 9 ^ Phone No
. Fill in fee simple tle H Ider o ne page.(if different E-Mail
from the Owner listed above) State or County License
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 anyy applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please cortsdrf-with yourflomeowners 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
improvey6eNts to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie C my nd posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len[der o an attorney before commenrin work or recording our Notice of Commencement.
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Signature of .her/L see/Con racto as Agent Tor Owner
STATE OF FLORIDA
COUNTY OF Lam41we
Sworn to(or affirmed)and su scribed befo me of Y Physical Presence or Online Notarization
this day of 20
I
Name of person making statement.
Personally Known OR Prod uc Identification
Type of Identification Produced (f
(Signature of Notary Public-S e of Florida)
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Commission No. Seal sejldx3 uolsslwwo0 AyV Z.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE-
RECEIVED-
DATE
COMPLETED
Rev 20 21