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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: g 0� I Permit Number: R(PT nv® � Buildina Permit Application Planning and Development services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, F©rt Pierre FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address: Property Tax ID Site Plan Name: Project Name: _ DETAILED DESCRIPTION OF WORK: Lot N o. c� (Q Block No. New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additi al work to be performed under this permit— check all that apply: .Mechanical Gas Tank _ Gas Piping , Shutters _ Windo�evs/Doors Pnnr9 Electric Plumbing Sprinklers — Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $_]C}„ Utilities: —Sewer Septic Building Height: OWNERAESSEE: CONTRACTOR: Name Address: ``1 Sac�cilC b��f -- _ Company: stoi City: State:. Zip Code:.6 Fax: Address: 2ZI I NpI " ` } Phone No. a j 44 - L k 2A_ City: r; 9 State:_ E-Mail: WL5Ob Go Zip Code: Swgrnt7 (.�i`-1 1j Fax: vr,- Phone No - L{ • y Fill in fee simple Tide Holder on next page (if different E-Mail At-Anwimsj JCQo ° from the Owner listed above) State or County Licensee[ ; I If value of construction is ?411ft nr mora a R rnar4en h1-a-;.....c ..-_..,.........,k.6o Q, 1s requirea. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: __1 UESIbNEK/ENGINEER: _ Not Applicable Name: Address:_ City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: � Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone BONDING COMPANY: ,Not Applicable Name: Address; City: 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 exemptfrom 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 {saying 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 Jap4er or an attom6 ore commencing work or record'recordin ur Notice of ComrRencement. qqq ; Signature o ner/ Lessee/Contractor as Agent for Owner Signature of tractor/License Flo der F° STATE F FLORID y STATE OF FLORIDA COUNTY OF -� 4 COUNTY OF �A r�/. 5wv to (or affirmed) and subscribed before me of Swor o (or affirmed) and subscribed before me of slcal Presen�� or Online Notarization h sical Presence or Online Notarization this day of 2021 by this day of 202 r by 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 Identification Produced Produced AMANDADUBOIS _ W COMMISSION ✓I GG 174 ti ILQ� EXPIRES: April 22,21)22 y�j P. Signature of Notary Public- Stat °.) AMANDADU94 (Sign re of Notary Public- S %� 1 MY COMMISSION # 174M4 Commission NO,: '? � C4 y]) EXPIRES:Ap6122, oc M2Dmm Sion N I.JqRd(Seal) F .., ennded Thlu iYotuy Public u REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 5/15/20