HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE OMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number C+I{
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Building Permit-Application
Planning and Development Services ,r
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: `_S& 14e- // -ILI. I b
Property Tax ID#: �7�` ��J�"-d�O� Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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C NSTRl1CTIONFI NFORMATP®N ._x � rr }A ��� Mti
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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: $ �0- ad Utilities: —Sewer ._Septic Building Height:
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OWNER/LESSEL=: ^� r �. CO TRsAFCTOR � w �'�a�5 •e�•t��.:.�'^s.,a;h�S�`ax��%L'�^;.�;�',.�"�3'.#'w�:.}�' ..r�Y�s�.o'.`3 �t"-vi�.�� -«� �?���v.�r`i?,.�-.,?t5f�..�'"'�-,�
Name Do Name: 754
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'I 4 c i 77i,,p'`Code Fax: 0 -! i��r_!r' Ci�ty:l mot. ..��rG/-C State: /�' /
Phone No.f 5 q 13 $g a� ``.��,! r�z i'p`Code`.Tr".'' • Fax:
E-Mail: �� Phone No 7 71 �g a' S/ ?
Fill in fee simple Title Holder on next page (if different E-Mail��G/'S�a.vC�oe��nA•
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.
U P IVI NTAL CO S7°R`U TIO` LLEN lAU1%�l'N ORi A` NN' ma-am,`
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 1 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 commencin work or recolrding your Notice of-Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF LUGtt; COUNTY OF L12,:fI
SworqA6(or affirmed)and subscribed before me of Swor (or affirmed)and subscribed before me of
V�Ph�y�si al Presence or Online Notarization Physical Presence or Online Notarization
this�y of 1 2021 by this day of 202� by
Sew T
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification ►/ Personally Known OR Produced Identification
Type of Identification Type of Identifica ' n
Produce ' (� fFt7�, �rl Produced
(Signature of-Notary Public-State of o "da) (Signs ure of Notary Pub ic-State of F i a)
Rebekah Hoy Rebekah Hoy,
.Commission No. mmission N. .
NOTARY PU NOTARY PU
STATE QF F RIDA Q' STATE OF FL A
Commt€GG2 94610 y Comm GG2
REVIEWS FRONT ZONIN UIff01t"l /2BP,0NS VEGETATION SEA TUR is NV1 �jJ Q �17 3
COUNTER. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
., .•, ..DATE.'. . _: _- .
RECEIVED'"
DATE
COMPLETED
Rev. 5/6/20
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