HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IPermit Number:
' RECEIVED
I . AUG 2 4 2021
d�1GIlt
. W.-INUM-2140W Building Permit Application ST. Lucie County, Permitting
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:
Address: V Vy U I ?y
Property Tax lD #: j40 Z -) 01-
Site Plan Name:
Project Name:
M5
_ Fl/1W1 _
New Electrical Meter Second Electrical Meter
Wa
Lot No.�$a
Block No.
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Additi al work to be performed undertliis permit —check all thayapply:
__MechanicalsTank /sprinklers
GasPiping ,+�`hutters �ndows/Doors Pond
✓Electric /Plumbing _Generator _L/Roof (0 Pitch
Total Sq. Ft of Construe ' n:- _ Sq. Ft. of First Floor: J
Cost of Construction: $YK N&I Utilities: ✓ Sewer _ Septic Building Height:
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Name O ` A SI Z(I-
Name:
Address: 0 G ( t
Company:
City: �p f1 51, LU �� State:
Addr
Zip Code: 3 4g5.3 Fax:
Ci t� \ _„ ' "
State -
Phone No. 2►- 3�
Zip Cod
Fax:
E-Mail:_pV�.r 3N t�ir cry Y
Phone N
E-Mai
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
it vawe of construction is 2500 or more, a RECORDED Notice of Commencement is required.
IF �v�6�n ..f 4A\/!':e C7 CM nr w►nrn a DCf`l1DflCfl Rl�:i•e wE (`n.Nw�n.��n.wnwf ie rnn��:rnel
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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 ublic records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to o consult
with lender or an attorney before comrp"cing WOW0,9 recprVing youir Notice ort me A-_
of Owner/ Lessee/Contractor as Agent for
STATE OF FLORIDA��. �U&'
COUNTYOF'
Swgrn.to (or affirmed) and subscribed before me of
Phys ✓ ical Presence or Online Notarization
this �1 day of Q�i1 �•@029 by
�ncx�L �VP�'1131r� 2fl�'1
Name of person making statement.
Personally Known OR Produced I
Type of Identification
Produced 12- L 01-
of Notary Public- State
Commission No.&&1 ,P9cr yq
- ,,,.,ww0 �w uoisslww loNepuo`
olZJ /o aiP,
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Nameof person making statement.
Known - OR Produced Identification
State ux
Cd . APR
My i�gian Kota,
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-ida) tRy Ashley Jo s►w
NOTARY P BLIC
STATE OF &Mossion No.
Comm# G 969944 .
State of Florida )
(Seal)
Expires 3
1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
REGEVVED
DATE
COMPLETED
nev. 5/b/20