HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: aa- 9. Permit Number:
LSLuC0LS " " D
ly - . , ..-, ° BuildingPermit Application «
p p 9t,PLuecle County
Planning and Development services g
Building and Code Regulation Division Commercial Residentia
2300 Virginia A venue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
- Wr
-
Address: d /, G
Property Tax ID#: 1 / "� ,000 Lot No. _
Site Plan Name:- //11 G.
Block No.
Project Name: 06b
5A-14 -
- Y�
~�
New Electrical Meter Second Electrical Meter (Affidavit required)
� Eil
ME
I ME
a
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:
x - —
Name < A, Name.
Address: /�U? Com.pa y
City: P1,4 f f Staf6..., 'Ad ress: '.
Zip Code: Fax: City: State: r
Phone No.7!77, 4/6r-302 0 Zip Code: Fax:
E-Mail: Ila A8.0, Phone No
Fill in fee simple Title Holde 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.
t
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable_
to
Name: Name:
Address: Address:
City: "h it `; ! 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-5uifding 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'fi'rst inspection. If you.intend.to obtain finan6ng, consult
with lender or an attorne before com mencirig work or record in our• Notice of Commencement.
Signature of Owner/Legsee/Con ract �t for Owner
(STATE OF FLORIDA COUNTY OF (c ,
Sworn to(or affirmed)an subscribed before me of K Physical Presence or Online Notarization
this ZZ day of 20Z' by
0
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
( of Notary Public-State of Florida)
c{ E
Notary Public State of Florida
Commission No. L (Seal) ; Alicia FosterMy Commission GG177104
p Expire,01121/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21
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..lf you intend to obtain financing, consult
with lender or an attornyy before commencing work or recording our Notice of Commencement.
FOwner/Lesse /Contractor as Agent for Owner
FLORIDA
F
Sworn to or affirmed) d si4lbscribed beforelme of Physical Presence or Online Notarization
this 6,qday of 20 by
Name of person making statement.
Personally Known OR Produced entification
Type of Identi ' tion Produced Ift
=State of Flo VAUGH
(Signature of Notary Public-State of Florida)
_Octo mission EX 'r0y9
`� � amber P es
Commission No. ! 0� (deal) 22' 2�22
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2