HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d'
Date: Permit Number:
�L CI RECEIVED
AUG 25 2021
° ` " Building Permit Application
Bt, W91Q 000tar
Planning and Development Services
Building and Code Regulation Division Com merCia I
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
pormliting
Residential
Address: ` 4 doC 0 mL C2P�n°iL�-'%L,
Property Tax ID #: �� _ ")�(c -�i� - U Lot No.
Site Plan Name: Block No.
Project Name:
0
14
0
New Electrical Meter- Second Electrical Meter (Affidavit required)
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 _
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $—.2Q422Q0 Utilities : _Sewer _Septic
Roof Pitch
Building Height:
' -:
ry
LLName
--
=
M/) _-f Chi- " ,i,
Name:
Address: H
Company:
City: �ltr� $tateiL.
Zip Code-�O 4--S Fax:
Phone No. - SnO9 Cz[9 _
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: llal
I m MpnicA- 1 pL
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a KtLUKUtU r4ouce or L.Umn+encenicnL a icyuucu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
9-1 G 14 1� q
NINE
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.
/� (� n : ��jr'p�••., MICHELL R SPARKS
N Notary Public • State of Florida]n.
. • r-. x GG 2 in
om' iss a
f w er Lessee/Contractor as Agent for Owner .��. ry C m
Signature o O n /g My ComrA. Expires Sep 22, 2022
Bonded through National Notary As
STATE OF FLORIDA
COUNTY OF
Swo�rn (or affirme ) and subscribed before me of Physical Presence or Online Notarization
�to
this --5 day of (G fi 2021 by
4
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
w1aL/= lm,tll
(Signature of Notary Public- State of Florida),-
" SPARKS
Commission No. (Seal) + ; iitate of Florida
GG 222291s Sep 22, 2022:•;:de
=h,
'al Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETE D
Rev 2 2