HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (!J - ^ or Permit Number: rb' o4, 7,
9 T. RECEIVED
° JUN 16 ,2021
Building pp Permit Application
Planning and Development Services Permitting 9ent
le County
lO nty
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:
Address: / 9'09 I -Id ZelWabc
PropertyTaxlD#: //'�� (� •v, Lot No.
Site Plan Name: .5-C O �- F%�d N Qd O R S Block No.
Project Name: - r0/y I D a 0 S
&Hi na AieLy Aurrl cnnlc 1 nA pgc /=ro,v f a/o oF,
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/ oors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 8 d Utilities: —Sewer —Septic Building Height:
Name 7'J'0_S-e_QA Sc D O Name:
Address: qj n 2e_1 wO1Ocls �Q . Company: r,
City: r ? el e rc C State: rL Address:
Zip Code: 3 L/ %� oL Fax: City: State:
Phone No.�/��J Zip Code: Fax:'
X
E-Mail: TUf 0 s e p f� Vg boo. co h',. Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:. Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 l 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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
�h (�
Swo n to (or affirmed) and subsc�etefor� the tff
Sworn to (or affirmed) and subscribed before me of
a� Physical Pres nce or Online Notarization
Physical Presence or Online Notarization
this -day of 2020 by
this day of 2020 by
Name of persM making. statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id tifi i n 1
Type of Identification
Produced 7
Produced
(Signature of Nota ublic- State of or1cfa U
(Signature of Notary Public- State of Florida )
Commis UMPHR a
Commission No.' (Seal)
~iy COMMISSION # GG 300817.
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REVIE S .g�F;fU
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I' erxrite
PERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
LATER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/20