HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOO BE ACCEPTED jn
Date: SCANNE Cn Permit Number:
By
St. Lucieftnty
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia. Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PFoperty Tax ID #:
Site Plan Name:
Project Name: _
Lot No.
Block No.
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in5}0111 MEW (auk( PA26-K90 ovl ew Coocrek Slade -w-
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CONSTRUCTION INFORMATION;
Additional work to be performed ' underthis permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters -Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof.
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
`G'ost of Construction: $ 9 i q 45. 7). Utilities: —Sewer _Septic Building Height:_
e
oin
Address:_ _2907 ('Arg(Vi f'fX
City:-FDr-y PIcree State:
Zip Code: '3 4 IS ( Fax:
Phone No. 2-7 3 X3- M %
E-Mail: Jsl n1ti7��C �� Q \iGtiOD•CO!✓I
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Pitch
Company:
Address:
City: State:_
Zip Code: Fax:
Phone No
State or County
If value of construction is $2500 or more, a RECORDED Notice of Commencement is req
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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PP PM = T L GONS
C 10 I W
0 ION:
MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable'
Name:
Address:
Address:
City:
Zip: Phone
State:
— __
City: State:
Zip:- Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON HE JOB SITE BEFORE THE FIRST INSPECTION.'IF YOU INTEND TO OBTAIN FINANCING, CONSULT
—"WIT1111,YOUiKENDERAWANATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:"
S na a of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF . „
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
tfCf�_ day of F4 20_ by
this _ day of , 20_ by
=cJ
�7
Name of person making statement.
N eto erson making sta ment.
Personally Known OR Produced Identification "
Personally Known OR Produced Identification
Type of Identification
Type of Identification '
Pr uced
Produced
S' ature of Notary Public-
§tateof Florida
(Signature of Notary Public -State of Florida )
Commission No.
a<,✓rd IASHAHTlN gAM-RAHMING
=��': MY COM g��N#GG 275000
Commission No. (Seal)
o EXPIRES: Decemberh0,2022
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