HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Z1 2-022— Permit Number:
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° 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:
Address:
Property Tax ID i
Site Plan Name:
Project Name: qcQ I l l l 1
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Constructions: ( _r
Cost of Construction: $ 8,455 cc)
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Lot No. 12 33
Block No.
(Affidavit required)
_Shutters _Windows/Doors Pond
_Generator Roof 0 122 ZPitch
Sq. Ft. of First Floor: I —1 U
Utilities: _ Sewer _ Septic Building Height: 2-5
Name in M t Nil
Name: U,mij
Address:
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Company:
City: State: ftll
Zip Code. Fax:
Phone No. E-
Address:
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City: Q
Zip Code:
Phone No_'(A
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State:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State or County License CCC 13 C�jJ
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
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
of 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 any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu 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 on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commenciniz work or recordinc vour Notice of rrammenrPnnPnt_
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Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA C�'
COUNTY OF r i U(
Swo o (or affirmed) and subscribed before me of Physical Presence or Online Notarization
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thiday of 20�y
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Name 6f person making statement.
Personally Known R Produced Identification
Type fld Pro uced
(Sign ur o�Public- ida)
Commission No. (Seal)
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eoYKATHERINE
MYCOMMISSONarH1199309
EXPIRES: DEC 04, 2025
Bonded through 1st State Insurance
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