HomeMy WebLinkAboutBUILDING PERMIT APPLICATION {
j All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
RECEIVED
ED /
k_x. Building Permit Application AU6 2 2021
Planning and Development Services At,W011;C�g ty
Per
Building and'Code Regulation Division Commercial Residential ` rnitti
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
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PERMIT APPLICATION FOR:
Address: 4C100 Sxkdg)W6 D2 roltr
Property Tax ID#: y0 a— 6 O-Y —01 2M DUO Lot No.
Site Plan Name: C 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: I Sq. Ft. of.,First Floor: {
Cost of Construction:$ "' j000 w Utilities: _Sewer _Septic " Building Height:
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Name 12Z�4 />< I �sVS.�FJV y = ,�,R" .
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Address: All/rs rL GAL,)( any; CtXVd /L ;F AA-f-Apy .SF Wr 0 '
e a� e"=� -•r e tiu^Itpt tYIJ� vas g�J'
City: JV1?ti'tlf�-4 State:_fj Address: 7A H Sw iTAu( JA*u4L1 D
Zip Code: 11CIS Y Fax: City: !!�(IA<: State:
Phone No. 7�I`�-6W— S3OJ E- Zip Code: 141ici') Fax:
Mail: Phone No '771 46o.' S366
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Fill in fee simple Title Holder on next page(if different E-Mail S4-ewp_rT (UUr, er a yri IG. Gy"Sing'Ti
from the Owner listed above) State or County License CJdL 13.46 0-&6
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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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address:.— Address:
City: State: City: State:
Zip:, Phone Zip: Phone:
FEE SIMPLE7ITLE'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'�sutijeet structure
which conflicts with any.applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure..Please consult with your.Homeowners Association-and'-review-your deed for any,restr,ictions'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 theJobsitel before..the first`inspection. If you intend id obtain financing, consult
'with.lender or an attorney'before commencing work&'recording,your Notice of Commencement.
Signature o wne Lesse Con actor as Agent for Owner
STATE OF FLOR_I ��
COUNTY OF �� �`((,,��
Sworn to Lor affirmed)'and subscribed be re a of Rh sical Presence or Online Notarization
this y of V{ 20 ��� -
CIC
Name of person making statement.
Personally Known ' OR Produced I e tifi ion
T f Identification Produced e
(Signature of Notary Public-State of`Florida) "
Ruth A.WWW
Commission NoC S al)- r° 8tate olF loilds'
REVIEWS FRONT ZONING ..SUPERVISOR PLANS VEGETATION. SEA'TURTLE ' MANGROVE
COUNTER REVIEWr.} ; REVIEW REVIEW REVIEW REVIEW REVIEW
DATE '
RECEIVED
DATE
COMPLETED
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