HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETE13,17011 APPLICATION TO BE ACCEPTED
Permit".61
Date:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Reside'iftial
2300 Virginia Avenue, Fort Pierce FL ' 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:4 bo
Property Tax ID #: Lot No.
Site Plan Name: 13lock No.
Project Name: f
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit — check all that apply:
$-Mechanical TGas Tank' —Gas Piping Shutters Windows/Doors- Pond
U
Electrlc mbing Sprinklers Generator = Roof _ Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 14-40
Cost of Construction: $ QQ tDo Le Utilities: 'J Sewer )(, Septic Building Heigh I t:
Name
Address:
City: —
State:
Zip Code: 34%/7 Fax: 11141600 V99
Phone No. -n;l a t Lo 44 5 (P
E-Mail: tiros a) Qo -c-ayh
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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iz mpany
Address:
—
City: Fbb� State --fi—
Zip Code: Qqqq:j, Fax:
Phone No-7'72-- t/0--ZtO4�-
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State or County Licensees (4 11 1—' 5- IL
If value of construction is 2500 or more, a RECORDED Notice or commencement is requircu.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
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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:
1,
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,comrnenced 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. l wll,.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: Youfailureao Recortl a Notice of Commencement may result m paying twice for
improvements to your propeYty A Notre of;Commencement n ust�.be,recorded&ln the public records of St.
Lucie County and posted on the jobsite before -the first inspection. If you intend to -obtain' , inancing,`_consult
:ILL -.1..... ..++.,.-.,e., k f,,.o i-r%m..Y anr_i.ncr-►A,nrIe nr'rpi•nrdinpy vnur Notice of Commencement."
Signature of Owner/ Yesreeok?acftor as Agent for Owner
Signa re of Contractor/License Holder
STATE -;OF FLORIDA
STATE OF RlDth
COUNTY OF Si j:Uw t-4 =
COUNTY Of
Sworn to (or affirmed) and subscribed before me of
Swo(or affirmed) and subscribed before me of
rn �a
Physical Presence or Online Notarization
this _j _day of irk Q U (! �1 202p by
Physical Presence or.. Online Notar tion^
this ,� day of �G— v+ /
V06'd' rr\0lk�+
Name of person making statement.
Name of person making statement. .
Personally Known 2�.— OR Produced Identification
Personally Known OR Produced Identification
Type of identification
Type of Identifi ati
Pr odu d
Produced
?ot�►� ��a ROBERT MOLIAT
,
(Signature of Notaryic- State da) (Signature.of o rhS -!'
mr Expires June 3.2024 ; ao< ` .� UDREY B. HUMPHREY
e
oFa (Seal Commission w
Commission No. �6q-7� �� � o`o s�edTin,euopot►bh�r _' :,_ MYcommiSSiON#q5,0gi(?97
ARardi 6, 2023
Bonded Thru Notary Public Und,,,ri
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/M