HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V ' G J�J Permit Number:
• - �
Building Permit Applica ion OCTC2 4 2099
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)46271553 Fax: (772)462-1578 Commercial. Residential .
PERMIT APPLICATION FOR: �C
Address: 9313 WINA fk r;i CA VL
Legal Description:.
Property Tax ID#: 17 C:J�2 . Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
WOW
17!S-0
Additio'nal work to _ e pertormed un er t is permit-check :.ill that appy:.
Pte"
Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors
_Electric _Plumbing _Sprinklers Generator. _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ oG L/0(J f Utilities: —Sewer Septic Building Height:
Name r✓dC I� C Name:
Address: 3 13. by)w6( (JAVAG l G Company:
City: State: /a Address:. ��� ArOVI-ei 150
Zip Code: q? S I Fax: City: Ll</k Stater
Phone No. 2-7 Zip Code: - Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E=Mail ryFp�/1 D I
from the Owner listed above) . .. State-.or County Licens
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
µ
,-
,
ar
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 certifythat 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 accordancewith 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 the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing w_D49r recording our Notice of Commencement.
Signat e o n.er/Lessee/Contractor a Agent for Owner Signature of Con��a� r icense Holder
STATE46F FLORID STATE OF Ft(ORIDA
COUNTY OF ' • COUNTY OFdel
�•
TheIr oing instr ment was acknowledged before me -The f�or'P�ing instru {�t was acknowledged before me
this- day of � 20 b", by thi:� day of ��7`' 2021.by
� h
(Name of person ackno ledging) (Name of person ack wledging)
0,L1d0J.JA1
(Signature of NotPublic-State of Florida) i
�r/ gnature of No Publi/c-State of Florida)
Personally Known OR Produced Ideifi Personally Known f OR Produced Identification
Type of Identi ' AUDREYB.HUMPHREY �r� Type of Idnt•fic
Produced aYP�a�;• Produce
GG 300817 HUMPHREY
EXPIRES:March 612023 MY COMMISSIC)N ft GG 3008117
Commission N �'s%�?a r`svters `'
Notary Pu � Commiss PIR S:March 6,2023(Sea
�; Bonded Thru Notary°uuIIC Undd-mrRars
REVIEWS FRONT ZONING SUPERVISOR 'PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.