HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO DE ACCEPTER
Date: I % ' 22 PermitNumber:
RECEIVED
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Building Permit Appkatlon JA N 31 2022
Planning and Development Services Wit,Ig tilify
, uidential
Building and Code Regulation Division Commercial Res f I
2306 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
'PROPOSED-_IimPROVEMENT LOCATION:
Address: 3� "I C aj±:f Ce rce L_ -S �f
,p.r, T
Property Tax ID#Z�d° l�lY1 r11V�� ' ��� Lot No.[7
Site Plan Name: Block No.
Project Name:
DETIDIPTI4N OF NQR<ASR
3 64)t 4
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors _ Pond
Electric ` PlumbingSprinklers _ Generator Roof Pitch
,,//
Total Sq. Ft of Construction: `f D Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: ,ewer _ Septic Building Height:
OWNER/LESSEE;, . CON`.i"RAGTORt
Name Name: y
Address: S Company: "
City: State: Address:
Address:
Zip Code: Fax: City _ Stater
Phone No. g Zip Code: _- Fax:
C-Mail: . � Phone Noa al,ffi
Fill in fee simple Title older on next page (if different E-Mail
from the Owner listed above) State or Count yLicei e I
C t?,� Le u
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,
i
SUPPIEMENTALsCONSTRUC ION°,LIEN LAW 1NFORIVIATIO.N% J
DESIGNER/ENGINE R: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: N Name:
AddreAddress:
City: State: City: State:
Zip: Phone _7 • T aL Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
of Applicable
BONDING COMPANY: . f.INot Applicable
Name: / `'
Address:
City:
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 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 Ipnripr nr an attornpv hpfnrp rnmmpnrina %Arnrk nr rprnrdinh vni it Klntira of f nmmcnromcnt
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Signature of Owner Lessee/Contrac a Agent for Owner
Signature of on actor/ ice-nse Holder
STATE OF FLO IDA
STATE OF FLORIDAoV
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_ Physical Pres nce or 0 line Notarization
this ` � day of 2021 by
_ Physical Pr sence or nline Notarization
this L?)� day of 2027.by
Name of person making statement,
Name of person aking statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
P duce
M
Produced
(nature of Notar P blic- State or YAK
o� NOTARY P
( nature of Notar lic- State f I
BLt �� NOTARY PU
Commission No. STATE OF
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LORIDA ESTATE OF FIL
73gimission No. ,. Comm# GG9 '
Comm#
W s/N g1�
4 •s�NCF 1g10 Expires 3/2
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