HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO M( 9NPMPLETED FOR APPLICATION TO BE ACCEPTED
Date: QEp 03 2021 Permit Number: zA 0 Q a 0()qb
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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:
Address:__4 L`J 2 7)Qh n3lo 1 Rd r a- rr± P1 e_ � `�4C15/ - -
Property Tax ID#: 13 Z_7" i 01— 0L02 --000,3 Lot No.
Site Plan Name: ' Block No.
Project Name:
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rh,
New Electrical Meter +° Second Electrical Meter (Affidavit required)
.:e �..'-=•3-'�y '� -$i".,�,"�-'� 31r-�;�-—sky s- �z�� t� � .�� � �,�.. .,� ,yea- � � e.. ��.�.:..:� _ ..
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank Gas Piping _Shutters —Windows/Doors _Pond
Electric Plumbing _Sprinklers `Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ , y GC%P C Utilities: —Sewer —Septic Building Height:
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Name,,41 ra �1ifi�1*0rSKyi Name:
Address: U $ray+ Company:
City:7( i-} a Lube State:EL Address:
Zip Code: 34 q 53 Fax: City: State:
Phone No. !6W %'95 g464 i Zip Code: Fax:
E-Mail: 0 r Vv 1 n Cars h1 Q MQI1 . Phone No
Fill in fee simple Title Holder on next page (if diffe ent, 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.
__MW
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 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
COUNTY OF 'S T Ltac�E�
Sworn o(or affirmedAnd sub ribed before me of Physical Presence or Online Notarization
this�day of 20�by
Name of person making statement.
Personally Known OR Produced Iden ification
Type of Identification Produced
(Signature of Notar Public- t e
ELLEN VAUGHN
Commission N FloridaNa4ry Public
=* *= Commission # GG 270079
9, Q? My HCommission Expires
lip OF,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 21