HomeMy WebLinkAboutPhillips AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number:
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: 0I,59(A lyrc. voofA V,
Property Tax ID #: \32-1 -101- O05b-000- O Lot No. se)
Site Plan Name: MOYM W16 C60Yl'Y(,I Nllb--UnCt thrt LDS' A Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
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: {�1/33 l Sq. Ft. of First Floor: n
Cost of Construction: $ ja iT b Utilities: —Sewer Septic Building Height:
Name
Name:Its-hr) Adams
company:Powernme flbmk
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Address:
City: State: _
Zip Code: Fax:
Phone No.
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Address: 11451 NO Um
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City: ftrkMIa rs
Zip Code: 3c✓ag1pl Fax:
Phone No 2Yi- My- (pV-1
State:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 0GicO`)l'Yil(1L aR6U)Y.Pr1btU
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State or County License dC moo
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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
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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 accessary 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 your Notice of Commencement.
01
4-4 0:777
Signature of mracctor - or - Owner Builder as
applicable
STATE OF LORIDA
COUNTY OF L C
Sworn to (or affir ed) an subscribed be � e me
day by
of Physical Presence or _ Online Notarization
th�i of 20
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Name of person making statement.
Personally Known X OR Produced Identification
Type of Identif'icatiion/ Produced
(Signature Notary PuV6-5t5te of Florida
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Commission Seal
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:'? - r G:. NotaryPubilc' State of Florida
IHC - State
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'Cb My ComComm, Expires May 5a 2025
banded through National Notary Assn.
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Rev 10/12/21