HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLINFO UST BE COMPLETED FOR APPLICATION PLICATION TO BE ACCEPTED
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Date: - 72 Permit Number:
ou. W1912
'14
9 Building Permit Application
Planning and Development Services
Residential
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
MRAu., AM-5
Address: 5�4 5g &4,4-r 4)ua, 5 Y� 5-r
Property Tax ID #: Lot No.
Site Plan Name: ro)11 le-,4 Block No.
Project Name: ?21
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DETAILED QEGRf 5xi QW ON 111
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New Electrical Meter C Second Electrical Meter
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Additional work to be performed under this permit -check all that apply:
Mechanical — Gas Tank —Gas Piping Shutters _,Y windows/Doors — Pond
Roof 7- Pitch
Electric Plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction: 3z7p Sq. Ft. of First Floor: T77-
Cost of Construction: $ 3 Z94 /19D Utilities: Sewer "Aeptic Building Height:
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Name mndv I." Name: DA 010 &VA4) K-Al
Address: V A V 6 &Od_Oi5A� )qJAe.6
,Ij4 Company:
City: a -r 57- State: Address: 00 7,--/L/ 0 44 0 IZA
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Zip Code: Fax: City:
Phone No. � 7, 6-Z 1 go Zip Code: ?2!tQ5'1 Fax:
E-Mail: Phone No -7-7 1, 0 IZI
Fill in fee simple Title Holder on next page (if different E-Mail- 70 I)F, D A J 6 6, o to(PA., Xmta
from the Owner listed above) State or County License e6clzs3jif
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.
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 restnmacty rpprhibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which 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,
tructures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
accessory s
WARNING TO OWNER: Your failure to Record a Notice of Commencemen ay result in paying twice for
improvement o your property: A Notice of Commencement m t e recorded in the public records of St.
Lucie CountyAod posted on the jobsite before the first inspecti . f you intend to obtain financing, consult
with lender r n att me before commencin 'n f Commencement.
work or recor o our N tice
gnature of Owner
STATE OF FLORI
COUNTY OF
ntractor as Agegt for Owner I Signature of Contractor
STATE OF .vGcl FLORID
/ LCOUNTY OF / / h-
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 2 <day of & ,,o At / _ 202F by p q v/P 6,1,
iA ill 0 &o U44 2
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Sworn to (or affirmed) and subscribed before me of
Ph cal Presence or Online Notarization
this Z day of 1;lnt e� 2021 by
Name of person making statement.
Personally Known —`. OR Produced Identification
Tvoe of Identification
(S' n ture of Notary Pu li tate of Florid ! (Sign1aiure of Notary P6h'Sic- State or riornaa�
Commission No. (Sea) l Commission No. (Seal)
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