HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 't Z1 Permit Number: 4j ,n ),33
RECEIVED
SEP 0 7
Building Permit Application 2021
St.Lucie County
Planning and Development Services Permitting
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: r mce,
4 - old . - 'K�f h'$P 9sk U .:3-
OF
OWN
Address: kkf A k[)
Property Tax ID#: TM 'S`'Is s Mby bob-1, Lot No.
Site Plan Name: Block No.
Project Name:
IN € ems- rFia. 7. .z,n ,�
10
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14
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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft: of First Floor:
d
Cost of Construction: $ ,�� _� Utilities: —Sewer- —Septic Building Height:
Name 'i 61 Name:
Address: �'(�G� AL'k CM Company:
City: IK LWk/ • State: Address:
Zip Code: Y CAI Fax: City: State:
'ti Phone No. TV_6'21,_M\ Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different 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.
I
DESIGNER ENGINEER: Not Applicable
Not
/ _ PP MORTGAGE COMPANY: _ 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 g anting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the -proved plans,the Florida Building Codes and St. Lucie County Amendments.
The following buildin permit applications are exempt from undergoing a full concurrency review: room additions,
accessory str ure ,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARN G O WNER: Your failure to Record a Notice of Commencement may result in paying twice for
pro em nts to your property. A Notice of Commencement must be recorded in the public records of St.
uci Cou y and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
it lend r or an attorney before commencingwork or recordingour Notice of Commencement.
1
S' nature O er/Lessee/Contractor as Agent for Owner
STATE OF FL RIDA 4.
COUNTY d Lt Gli
Sworn t (or affirm ) and subscribed before me of Physical Presence or Online Notarization
this day of Wt-L
20.2 1 by
C-4 even me (,se r
Name of person making statement. ,,
Personally Known OR ed Ide tification d/__'Si �-
Type of Identification Produced
all- V
(Signature of Notary Pu li -State of orida)
AUDREY B.HUMPHREY
Commission No. (Seal) =_°' MY COMMISSION#GGMOW
EXPIRES:March 6,2023
{3onded Thru Notary Public Un �S
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev S 2 21