HomeMy WebLinkAboutBuilding permit appA (-ir i(-�rn o
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:%P' .1q -- --;)-D Permit Number:
_.. - Building Permit. Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462.1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENTLOCATION:
'Address:
p1qRgMCTax ID #: Lot No.��
Site Plan Name: - Block No.
Project Name:
ETAILED DESCRIPTION OF WORK:
5U r,C'bf ►Pr io 1 t f'q afl'-=-� --I 3
electrical Meter Second Electrical Meter
CONSTRUCTION INFORIVIATI(
Additional work to be performed under this permit - check all that apply:
—Mechanical Gas Tank _ Gas Piping ,_,T, Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing Sprinklers
Total Sq. Ft of Constru 'on:
13,
Cost of Constructi hr $ c ��� �D
Generator Roof Pitch
Sq. Ft. of First Floor: oma- S c,)
Utilities: —Sewer _Septic Building Height:
Name ►� �� �"��a S i'
Addr-errs-- 3'5���
city: ""1y' �- State:
Zip Coder 94S Fax:
Phone No.
Mail:
Fill in fee simple Title Holder on next page E if different
from the Owner listed above)
I, I
i e_ IS, 4e—
ACfore55: T 21 l I z.? C:;— -
City: �~e�G State: ►� 1
Zip Code: GI Fax: -1 `7 H Lo 1,Q Apa!:V
Phone No -7-
J-Mair
State or County License.bC�.3
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.
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 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 lender ora attorney before commencing work or recording your of Commencement.
Signature`of owner
r as Agent for Owner tignature of Contractor/License Holde
STATE OF FLORIDA.—STATE F I STATE OF FLORIDA
fit
COUNTY OF _ -,,, r _._ COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ) &fday of r 1> 20 a.O by
Name of person making statement
Sworn to (or affirmed) and qubscribed before me of
_- L Physical Presence or Online Notarization
this ILD day of n52_ . 20_-_�D by
Name of person making statement
Personally Known _ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( ignature of Nota ublic-
'� q 4 L •;,: o ission # GG 025069 (S na r of N t ublic- St t, ilk Y REIN
} lies November 18, 2020 n �'� ;, commission # GG 025069
Commission No p�D r .,
pORi� 6�ruTlCf Fein Masre+oeeol}�o�o mission No 5e %-Em Vovember 78, 2020
hN�'��d 17gFihlnWxtncr BDA,1
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETI=n
SUPERVISOR � 1 PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW