HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �ID� 011.3
Permit Number:
D t
a e.
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Bufldicng Permit Application
Residential X) ... -
Address:/�.�I::-)
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Property Tax ID #: tlL/�c, - ?b LI! , VC) I � �� D ~ Lot No.
Block No.
Site Plan Name: ..
Project Name:
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ni—i Glortriral Mptpr Second Electrical Meter (Affidavit required)
Additio al work to be performed under this permit -check all that apply:
echanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors,. — Pond
Generator Roof Pitch
Electric _Plumbing _Sprinklers _ —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:
L Gd Utilities: _Sewer Septic Building Height
$ l `/�' .
Name
Address:
City: o
Zip Code: S ��Z0
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: -4,)Aq611
Company: WG
Addres .
City: zG
Zip Code: LDS Fax:
Phone No17,2- e?6f
E-Mail
State or County License G/4 C
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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State:
Mod Rmn
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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 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 lend or an attorn b re comme ing work or recording our Notice of Commencement.
Sign e of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF oar
Sworn to (or affir ed) and subs
this �day cribed before me of Physical Presence or Online Notarization
of 20ZI by
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Name of person making statement.
Personally Known OR Produced Idpntification
Type of Id tifi.cation Produced L.
(Signatur of NoRtary Public- State of Florida )
Commission No. (Seal) iNGRpµ-RAH��G
VY
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EXPIRES:��—D-ec-e—mV1�y�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21