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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: T Z/D�o • CJ,SoZ� CE1\1 ,uM.lBWA Building Permit Application Qepa�``"epY Planning and Development Services per SC CuCie Count 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: PROPOSED IMPR©UEMENT LOCATION: PropertyTaxlD#: 0�'S��� -60/- 60 60—�oo/C� Lot No. Site Plan Name: uJ/%�of�'�ha, Block No. Project Name: _-7,e-l-� 59'J-74,7' New Electrical Meter 1// Second Electrical Meter Additional work to be performed under this permit - check all that apply: I Mechanical _ Gas Tank _ Gas Piping' Shutters _ Windows/Doors -L, Electric Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: % S>> Sq. Ft. of First Floor: Cost of Construction: $ Utilities: Sewer _ Septic Building Height: Pond Pitch OWNER/111@8` EE: CONTRAPPCTOR: NameGlos�iGi 2 Name:_/1Py�G �P_�ra/' �C�lGir/c� Address:.3ZOO S. T Ste. /v% 7 Company: /� l Awe, City: A;gxe�, 6L� State: _ Zip Code:Fax: Phone No. >?Z? aZC�>- 6Y65- Address: 3Z0,;_­ S. City: �a��ciCL Zip Code: Phone No 27Z26'i2z--1-,1_V �G State: Fax: E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail ciao tc? favr�22/`i'� G� c� State or County License_�f��//� 3/3 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. DESIGNER/ENGINEER: Not Applicable Name: Address: 9 o City: .S' . 1 Gi 5tate:9'--4/_ Zip: 7�� 3- Phone f�� 2 FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Name: Address: City: Zip: Phone: BONDING COMPANY: Name:_ Address: City:_ Zip: Phon Not Applicable State: Not Applicable 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 . ;Fk 1onr4mr nr on 7ttnmaxi hPfnro rnmimpnrina wnrk nr rer_ordinE vour Notice of Commencement. i Sign r w Lesse Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S I- LJL.Zlr COUNTY OF Sworr ti (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization Physical Presence or Online Notarization this /0-day of SUrw 2021 by day of 12020 by Name of person making statement. '%;��� 0 o�J e of person making statement. Personally Known OR Produced Identificatio ' »' rsonally Known OR Produced Identification Type of Identification To o 3 o pe of Identification Produced 1JZ� !m 3 oduced _y 3 0 1 � � _1 `Cy7n A In (Signature of Notary Public- State Florida Signature of Notary Public- State of Florida ) NUWCT Commission No. (Seal) y N 0 Commission No. (Seal) v v C7 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 5/6/20