HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: � , Permit Number:
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Building Permit>Application 17 2021
Planning and Development Services
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Building and Code Regulation Division ComrTlercial Residential
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Property Tax ID'#: �333� �3y, O6�d- 4ao - "zk, Lot No.
Site Plan Name: Block No.
Project Name: 6_14A4Nb "yZ_ Kid A4Erit1 3- # _
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Ne"-ctrical Meter Second Electrical Meter'
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Additional work to be performed under this permit - check all that apply:
_Mechanical Gas Tank Gas Piping _Shutters _
ti .
_Electric Plumbing _Sprinklers,`-. _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Cost of Construction: $ �/.I��,(j ao Utilities: —Sewer —'Septic Building Height:
Name z n ewK-
Address: C18 Aci
City: I �� i'' State:
Zip Code:�Yqlsr�`Fax:
Phon,e:Ao.- G�
E-Mail:. evry �alri0
Fill in fee simple Title Holder on next page.( if different
from the Owner listed above)
Name: c—1 A!±IZ5 • C.,C'15r
Company: 0,4L5-7—
Address: A�
City: . 10,e -6� State: F�
Zip Code: 3 92-- Fax:
Phone No'.�Z,�
E-Mail
State or County License �}pJ �'� OW-22 d
-If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,5C0 or more, a RECORDED Notice of Commencement is required.
DESIGN)t/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: f A-uL l u Name:
Address:-9B:F: 5uo G3�1 �a•�� �i v >✓ Address:
City: PoY '5�- !'�`re. State: F(— City: State:
Zip: i 6'I ', ,, Phone '7'7Z ; ZfS—� 8 Zip: " Phone:
FEE SIMPLETI?TLE-MOLDER: Not Applicable
BONDING COMPANY: Not Applicable
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Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made,to obtairna`;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 Twill,` iri'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 o;f,St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne before commencing work or recording our Notice of Commencement.Z"
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signat a of Contractor/License Holder ,
STATE OF FLORIDA
S ATE OF FLOR
COUNTY OF
UNTY OF
Sworn to (or affirmed) and subscribed before me of
Sw to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Ph ical Pr or Online Notarizati n
� �
this day of , 2020 by
this day o �y
�meof rson making/statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced i
(Signature of Notary Public- State of Florida)
(Signature of N ry Public- State of Florida )
Commission No. . (Seal)
Commission No.
UDREYB.HUMPHREY
MY COMMI 3!ON #� GG 300817
. 4:=
EXPIRES: March
, 2023
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