HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 �� Permit Number: C7�/ O
0 RECEIVED
Building Permit Application JAvgo-partmeri
1
Planning and Development Services Permi
Building and Code Regulation Division Commercial Residential St. Lucie Counr�'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
PropertyTax ID #: /3,016 dry- O/Qq - 6e&!> % Lot No.
Site Plan Name: A�:a1/-C ',fzaod ,� �� iJ'dZ, 0-e Z6 W 'b'd-t1',()F--Block No. �_
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
`Mechanical _ Gas Tank _ Gas P in — shutters —Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprin rs ` Generator - Roof .Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $� � r, Utilities: —Sewer _ Septic Building Height -
Name
Name:
Address: '77 D�,4Loe iryj2
Company:
,�'
City: /,P�' ,_
Zip Code: e o.< Fax:
Phone No. 36 44V
State�'�
Address:
City: State:
Code: Fax:
Phone No
tzZip
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
DESIGNER/ENGINEER: _
Name:
Address:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOL!�t _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: hone:
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
,A,Iti, I nnrlpr nr mn attnrnPv hafnrP rnmmpnring work or recording vour Notice of Commencement.
Signature of Owner/ Le see/Contr for as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sw?.pir-to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Pbysical Pres a or Online Notarization
Physical Presence or Online Notarization
this �day ofC4 by
this day of 2020 by
�va2
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi ati, n J_-,
C.
Type of Identification
Produced
Produced W/" i
OtL4=�
PHR
(Signature of Notary �'syate'o!,�7n
(Signature of Notary Public- State of FloridaGG
300817Commission
No. t; ? 6,2023
Commission No. (Seal)
•a'
lic Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b/2U
MY COMMISSION # GG 300817
EXPIRES: March 6, 2023
Bonded Thru Notary Public Underwriters