HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: D!-
Permit Number: ow V 110
RECEIVED
L�
OCT 12 1010
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Building Permit Application permitting Department
Planning and Development Services 5 .Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address:Ml5 1TPliIY)AX Lnd ,d/'
Property Tax ID#: b 01Lot No.
Site Plan Name: Block No.
Project Name:
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DETAILED DESCRIPTION f®F�WORK p �? � h-r
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit–check all that apply:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plum'bing' _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction,: �7 Sq. Ft. of First Floor:
Cost of Construction:$T7 / LUtilities: —Sewer _Septic Building Height:
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OWNfR�LES�SEE= � ,� �fCON,TRATOR r
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NameAW r31� 1P�' Name: �/'
Address: --rCompany:,
City: o State Address: �i+f►n�.e r'
Zip Code: Fax: City: State
Phone No. Zip Code:z�'G7'I�b Fax:
E-Mail: Phone No�� 7-2—/40/
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
�SUPPLEIVI'ENTAL CxONSTRUCTION�zLIENrLAWJIJVF-nORIVI;4TION
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 or an attorney before commencing work or recordiDg your Notice of Commencement.
na re o ner/• a ctor as Agent for Owner g ature Gfifontra5 /[_NVsHolder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
� Physical Prese a or Online Notarization / Physical Presence or Online Notarization
this��day of 2020 by this �
day of l�� 12020 by
Name of person making sta ent. Name of pers n makings tat ment.
Personally Known OR Produced Identification '� Personally Known OR Produced Identification
Type of Identif . n Type of Identi icati n
Produced (' Produced )-c-
4
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(Signature of N of N ry Public-State of Florid)
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;ot;?Yyio6"-' AUDREY B.HUMPHREY ;s�;r•(;-, AUDREY PHREY S
Commission No. = MMISSI� );300817 Commission No. � -P"
COMMISINGG:00817
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March arc ,2023 i1
o tr+cs EXPIRES:March 6,2023
_ Ws Bonded Thru Notary Public n erN;,er; '
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE-1A-fr6i A TLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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