HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED,
Date: ~ Permit Number: J
RECENED
• 4 FEB 0 9-2021
o
Building'Permit Application perrnitting artment
Planning and Development Services St. Luci 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 6 C4 O sp-;P�O 46i-& Q D O
f
Property Tax I D#: t c) t — "0 Qo Lot No.
Site Plan Name: Block No. 1
Project Name:
.DETAILED DESCRIPTION OF;WORK
-J4
v
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed. under this permit—check all that apply:.
_Mechanical =Gas Tank —Gas Piping _Shutters _Window /Doors Pond
_Electric _Plumbing _Sprinklers _Generator oof Pitch
Total Sq. Ft of Construction: 7 G 0 U Sq. Ft. of First Floor:
r
Cost of Construction: $ 1 2 Z>_3 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: -'CONTRACTOR:
Name . Name:..- 6%,
Address: Company: Qo
City: State: Address:
Zi Code: Sq ?c�� Fax: Cit .�,
p y: �1 Stater
Phone No. Zip Code J��J J Fax: 7 70-•�-/fo ��?
E-Mail: Phone No q(zs'-o zr—>z—
Fill in fee simple Title Holder on next page(if different E-Mail cAm-, V\A,vad 9"N
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.
S.U,PPLEMENTAL CONSTRUCTION LIEN LAW•INFORIVIATLON::
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.
Signatur f wner/Lessee/Contractor as Agent for Owner Sign ure of nt oractor/License Holde
ATE OF FLORIDA c' STATE OF FLORID
COUNTY OF L.!/ COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to (or affirmed)and subscribed before me of
�P,hysical Presen or Online Notarization / Ph ical Preser! or Online Notarization
this day of 2026 by this day of 2GZCrby /
Name of person making statement. Na of person maki statement.
Personally Known/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota` Public-S te� (Signature lorid )
'avvi%• �AUDREY B.HUMPHREY •• AUDRL='l�'• �7
a"•*1' EXP • � z•Y FUr'., YC O�'�'�''Commissio .eg Com I�F10 �[, h
i�3 EXPIREIRES: jach 6.' SEAr 4 G32 Dd2738?r�c?' Bonded Thcu
---- yy,�s,�-r,•rJ! -.� .^lam_.-may..
REVIEWS u FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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