HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�N
RECEIVED
U JAN 15. 2021
Building Permit Application Permitting Department
Planning and Development Services
St. 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:
PR'®P�OS�E® I PR® I✓MrrNTL ;®�It: 4` -
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Address: SSSo1 L4s'rwoo6 D9l,)L Fo1Lr Pit.a.e Pt_ 344SI
Property Tax ID#: 13ot -bi3 - 00%W cc Lot No. 14
Site Plan Name: Block No. i 3y
Project Name:
IN STA t.t_ FLNCl4 - 4 VT CU^tN t_%n k FrNt te 2.00 FT ik LeNyH. WA oKc &+t
aLoc4 Cq SouTW Qwbw LtMc' of P2olptr�.TT _-_AfTt-V `:HL- FacT.
New Electrical Meter Second Electrical Meter
CO „ISIRO NF®RMANO
TI_C?4N
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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 _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ G:o.o'0 Utilities: —Sewer —Septic Building Height:
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Name tZOGr-N- A G4jmr4 Name:
Address: 15;So1 csxgtwoaa Company:
City: Fa yT State:�L Address:
Zip Code: . U$S Fax: City: State:
Phone No. -t- lS%o Zip Code: Fax:
E-Mail: 5h1►%A_:'aw+ 62 gakoe . Corn Phone No
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.
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 recording our Notice of Commencement.
Signature of Ow er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sgrn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pr ce or Online Notarization Physical Presence or Online Notarization
this day of UJ fi, ZOO by �2 f this day of 2020 by
Name of erson making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
rz 1 2�/
(Signature o Notary ublic-State of Florida (Signature of Notary Public State of Florida)
Commission No. �: ommission No. (Seal).
..
EY B.HUMPHREY
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MY cOMMISSION GG 300817
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REVIEWS FRONT ,. " : ZQNI`�� �;s ,_c `{ i"t rs DNS VEGETATION SEA TURTLE MANGROVE
COUNTER'" REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Y B.HUMPHREY
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EXPIRES:March 6,2023
c yrF °Pn Bonded Thru Notary Public Underwr tors