HomeMy WebLinkAboutBuilding Permit Application All APPLICABI.E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
D, Permit Number:
20q- 353
NJ if o F_Uc ll.s
�` •. ` °R -v ` Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential �/
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (i 72)462-1578
PERMIT APPLICATION FOR:
IN-
R � C
Address: �I- ) ( ' I �^^ Z`1�1" I 6� ep�� (( ((��� �
Property Tax ID#: aLA d S,_ �Q � 0 V9 V-•-0 00- G=o Lot No.
Site Plan Name: Block No.
Project Name:
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tity, d,r-oo m
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
Ele6tric " Plumbing
lumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Wo ' Utilities: _Sewer _Septic Building Height:
�f WV - _ - s.F-s-^met-s.. - �.� b - •--- a
Name U V I ue Name: I Iil j,, c e
Address: (z ,,/L'C��} It�� �) 1/CX Company:
City: T71k-p) Qr `�-'e— Stater Address:
Zip Code: AUCIE I :Fax: City: State:
Phone No. rl rl "2- 9 Q )rq 2 SE-�— Zip Code: Fax:
E-Mail: R gCCIY-I C)l..(,e :� (�D RIq('()'lt(CC Phone No
Fill in fee simple Title Holder on next page(if ditt- e� 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.
WE
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V 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
improvement to your property. A Notice of Commen men! must be recorded in the public records of St.
Lucie Cou ty a posted on-the jobsite before t e first nspection. If you intend to obtain financing, consult
with lender r an ttorne before commencin work o re6ording your Notice of Commencement.
IW� .
Signature of Own r/Lesse Co ctor as Agent for wner
STATE OF FLO I A
COUNTY C fYl
Sworn-to)(or affir ed) and subscribe bef me of Physical Presence or Online Notarization
this tn'day of by
Name of person making statement. /
Personally Known OR Pr duced I ifica 'o
Type of Identification Produce T7'
(Signature of Notary Pu ppic-State of orida )
GJ (Seal) �� PRISCILLA NiARIE REYES GAMEZ
Commission No. r
Y COMMISSION#GG325831
PIRES:April 18,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS GETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW R VIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21
Rw�
Now
DESIGNER/ENGINEER:` !Not Applicable MORTGAGE COMPANY N.ot 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: I 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.
Inconsideration of the granting ofithis 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 Ion the jobsite before the first inspection. If you intend to obtain financing, consult
with er or an attorney before commencing work or recording our Notice of Commencement.
lCY,
Signature of Owne /Less ee/ContlIr cto as gent for Owner
STATE OF FLORIDA 1 r
COUNTY OF 6
f
Sworn to(or affirmed and Ascribed before me of Physical Presence or Online Notarization
this C4 day of 20Mby
Name of person making sta ent.
Personally Known OR Produced Identification
Type of identification Produced
o.P Pie, LEN VAUGHN,
(Signature of Notary Public- i of Florida ;* *`State of Florida-Notar
/�� a; Commission G y Public
Commission No.l3y C rS (S 1)"OFK My Com C 270079
mission Ex
Oeteb�r 2� Aires
�. s 29��
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
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