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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFP M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �r1 Date: / Permit Number: O 9-©i yJ �� L-l�_1�Q�-• �\ RECEIVED O a SEP 0 3 2021 Building Permit Application Planning and Development Services St Per e' inunty 9 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: _ _ e Address: 7 6. Property Tax ID#: `301 ��- 44�=� Lot No. Site Plan Name: Block No. Project Nam e: (� yW-1 -= , ` . m 'Y73 ti g. ,3., bi - M1 m= .• 2 w Electrical Meter Second Electrical Meter P (Affidayit lee /V Additional work to be performed under this permit-check all that apply: (2) u _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: $_ Q� Utilities: —Sewer _Septic Building Height: -.�:" y c•� :.r .�} �.� a�'y;+s^e �� 3 ° --�f ?+ #5�"�_. ems. � �r ', �,::.'.t°- �E .� .� �s.�-.'---"' h' f .,�.eh•e'i� „�d� - - �, F_ §' Name Name: Address: Company: City: ! � State: Address: Zip Code: Fax: City: State: Phone No. 4ffZip Code: Fax: E-Mail: Phone No Fill in fee simple T/-,;ted Holder on next page( if diff rent E-Mail from the Owner I 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. i r*r.���sr�a��,..�"��`'� �td�sa � r ��: -�r•r-ter -a• Y a=r � F���� �^_ �s�'€�. �+�a�'r `.t � DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: el\_ 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 N ce of Commencement must be recorded in the public records of St. Lucie County and posted on the jo b, fore the first inspection. If you intend to obtain-financing, consult with lend r an attorne be e c m cing work or recording our Notice of Commencement. SignatZF of Own r/Lessee/Co tractor as Agent for Owner STAT FLO IDA , COUNTY OF Swor to(or affirm )and ubscribed before me of Physical Presence or Online Notarization this day of 20�� by 4 vt4 22e Nam of person making statement. Personally Known OR c d Identificatio �— Type of Identification Produced (Signature of Notary Publi tate Florida) -� b�"•"vPy"B`.: AUDREY B.HUMPHREY .RY P(�'�'. Commission No. (Seal) MYCOMMISSfOiJ#GG300817 ;z�• -, At1pftEYB•NUMPHREY t+ EXPIRES:March 6,2023 y�i .= MY COMMISSION GG 30081 vp�?`o`.= =Ei , P,!L,ic l.ndenvriters '�":, P, EXPIRES:March 6,2023 ! ._.--;:.,;,,,•,::l:.,;.�,.1.:,,•,�rr.�r���=r- �°sue ­..,,,,-• Bonded Thru Notary Public UndernrrS REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 20 1