HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , a Permit Number:
9�C.LU CC!HE RECEIVED
o= JUN 0 1 2021
Q,�c (D._M- c+ Building Permit Application
Permitting Department
Planning and Development Services St. L,Z County
Building and Code Regulation Division Commercial Residential J�
2360 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
T a
PROPOSED IMPROVEMENT LOCATION:;
Address: JCS I �--�1GkorM... c� ,
Property Tax ID:#: -�Sfa01 - Go -9- o Lot No.1_
Site Plan Name: . Block No.9—
Project Name:
DETAILED DESCRIPTION OF,WORK
g�5�n t I ngw
-64 !s nn S E o an-d vim.
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 _Windows/Doors _Pond
_Electric _IPlumbing _Sprinklers _Generator .Roof Pitch
Total Sq.Ft of Construction: !! Sq.Ft.of First Floor:
Cost of Construction:$_ /aiAdO Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Q t!'iA ,In InName: ion- G Q G
Address: e�� I� f-�� �y Company: f'Q. U(`Q, Cno p
City: or /�/Gice State:f- .Address: / L.J _
Zip Code: YLV 3 Fax: City:� 1R� �� e, Statet
Phone.No. Q ('`jd 6 Zip Code: Fax:.
E-Mail: Phone No 7 2.41 c' 1')Q
Fill in fee simple Title Holder on next page(if different E-Mail C L,C
from the Owner listed above) State or County License (,C .)
FEE
value of construction is 2500 or more;a RECORDED Notice of.Commencement is required.
of HAVC is$7,500 or more,6.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:
t
ESIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
me: 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 r ess /Contractor as Agent for Owner Signature of Co tr r/Li nse Holder
STATE OF FLORID STATE OF FLORInA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before a of Sworn to(or affirmed)and subscribed before
V—Physical Presence or Online Nota a A4hysical Presence or Online Notari tion
this day of 2020 b this_day of 2020 by
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Name of person making stateme t. 3 3 Name of person making statement, ,�
3 3'0 < 000
Personally Known OR Produced Identi A.`& Personally Known OR Produced Identif a>$ w
Type of Identification 3 � 5 Type of Identification 3 3
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Produced c X rn D Produced m v o
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(Signature of Notary Public-State NforldaaLL ) a o o (Si nature of Notary Public-State of Flo da) G)m m m
.27412 ^N a .? �?r� (Sealy �' 1-n o
Commission No. (Seal) N w Commission No. o 0
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REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION SEA TURTLE Xk
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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