HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) n
Date: 0 �J o W24 Permit Number: �/ IJ �l v 07.
RECEIVED
�L 5EP 9 3 2021
Building Permit.Application at wow ry
Planning and Development Services Permittin
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:�u S,h drl �lVlG1 �IS ,�(l{✓�0V1G>�
PRCtOSED IMPF�0IIEMNT LflCATI }N R '
Address: l I 6q l ro ,DY I v& ,y -6 r- P IC,f7..
Property Tax lD#: 34-02-- (a0-! 0555 1 00 0 — Lot No.Zd72
Site Plan Name: Block No.
Project Name:
TAIEDi~SCIPTiOv
New Electrical Meter Second Electrical Meter (Affidavit required)
:G�NSTRUCTICrN=IIFORII�1`ATIQNy'
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: $ " Utilities: —Sewer _Septic Building Height:
C31htNERf LESSEE• � " ;.. `>CC�NTRACTQR w `
Name Shy *Yl Name:
Address: ,Sqt Palm DdV& Company:
City: State Address: _
Zip Code: Z pp,,€ax: Sy'ZIT q(p5Z City: State:
0
Phone No. 7Z• Z' '✓I E- Zip Code: Fax:
Mail: 0 l.&OW 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.
y��l�pl.1=NIEiVTAL�oNS'TRl�GTION`U�N LI�111� IN�t�1�MATION� E ` � � ��,� `�,�E �
a
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 conflicts with an�applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners 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 t ' bsite before the first inspection. If you intend to obtain financing,consult
with lendereor an attorney bqTore\commencing work or recording our Notice of Commencement.
A ,(A, "�LOIL )
SigrkdrYof ner/Lessee/Contrac r as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed b ore me of _Physical Presence or Online Notarization
J��-
th8_day of I by
Name of pers n making statement.
Personally Known OR o ed Identification
Type of Identification Produced '. C _
(Signature of Notary VIO State of Florida}
Commission No. (Seal) AUDREY B.HUMPHREY
Rol'COMMISSION n GG 300617
jam.-z EAARP^:March 6,
tx-a.a.��31x �i y'r; ts;Jc �rf
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
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