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HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Planning and Development Services 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: 51e_G74-,,G fi)alq-&1re Address: /ODS F/Oodi�fP,, 4:� ?c� ��— Property Tax ID #: 34'cocF — So / — n5"C'6 — O., O — 6 Lot No. Site Plan Name: Project Name: New Electrical Meter Second Electrical Meter C©NSTRUTt( ili�ltl�l'`It�:1 :;>::<::::: Additional work to be performed under this permit — check all that apply: _Mechanical _ Gas Tank —Gas Piping _ Shutters (Affidavit required) _ Electric J< Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction; Cost of Construction: $ Sq. Ft. of First Floor: 51MS M Windows/Doors _ Pond Roof Pitch LDS Utilities: Sewer Septic Building Height: Name Address: City: e State:,'& Zip Code: 3cf 98Z-- Fax: Phone No. 1�_Y' E-Mail: Cr1"2 Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name: Z;42�e9/7. 5 /`�o4�Y , Company: /C-071-ip Address: /`30/ City: /4__1A State: r-;e_ Zip Code: Fax: Phone No 6. -v E-Mail /�/.'cGol� '� �RSC • f�A, 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. ...... ... ...... ....... .......... - .. .... SUPPLEMENTAL �fl �.RU�TION LIE�1 LAW..[NF�RMATICIN: .. .................... .. ; :: DESIGNER/ENGINEER: _KNot Applicable MORTGAGE COMPANY. Not Applicable Name: Name: Address: _ Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: oC Not Applicable BONDING COMPANY: _ of 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 lender or an attorney before commencing work or recording our Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA o�J�O� COUNTY OF Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization thislay�of 2,202-1 by J� e Name of person making stateme t. Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public- State of Florida ) ;c`°Y pueG - NICHOLAS rr.l'-i 00 Commission No. (Seal) ;:; • �: Notary Public - Sta-e o` ;brida of Comrnis,i r _ GG 422464 My Comm. Evores Oct 22, 2023 Bonded thrnugh 1�auorsl Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev