HomeMy WebLinkAboutBuilding Permit application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6�7�ZAz� Permit Number:
9Mu.IUP COTE REcEM®
Building Permit Application 7 2029
Planning and Development Services Department nt
Building and Code Regulation Division Con1mercial Residential ep ��aeCounty
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION- FOR:
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Address: C /eve,
Property Tax ID#: : 3619" 901- 000/- 000-0 Lot No.
Site Plan Name: Block No.
Project Name:
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New.Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping. Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: "_Sewer , _Septic Building Height:
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OINERCLESSEL� ti CONTRGwR
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Name �G� �e�/ W• fOeWl1� - Name:--
Company:'.
City: Orf ��r4C _:;`StateR.'. Address: V!i
Zip Code: .3Ygq!_ Fax: City:^ State:
Phone No. 77,a•33a'IVd Zip Code: Fax:
E-Mail: /lut�40r&hCl, a of CO/P 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.
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SUfPlE11%IENA!CONSTf�UGTlON LA INFORMATION r = " ter
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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: 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 grdn.ting 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 forany 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 c mm6ncing work or rkording your Notice of Commencement.
C., �of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF /
swor (or affir d)and subscribed before me of ✓ Physical Presence or Online Notarization
this day of 20'_1 by
ap—
Naron making statement.
Personally Known OR P o ed Identification
T fib
y .of Identification Produced
( 1 nature of oar u lic-State of Florida}
riY?q1; AUDREY B.HUMPHREY
Commission No. (Seat) MY COMMISSION#GG 380817
EXPIRES-March 6,2023
,•rFuc�;�c' Bonded nfu Notary public unde+mms .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION" . SEA-TURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
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