HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED ,�+�
Date: Permit Number: Ul ) O� 0So I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residentia
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: "( Z)( N S o! -" t 77
Property Tax ID #: 2 zl O S'i p —3 Lot No._
Site Plan Name: Block No.
Project Name:
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
V Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ /2bt9 Utilities: _Sewer- _Septic
Building Height:
Pond
Pitch
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Name Lot iDr`Gr' F�'�/J�-tiS "=I
Name: )c.�i9�� c�mir lfi
,PI4
Address: 3 f'e 03 }'?'? Vk N1:' '.-, : - = `�
Company: fM . 7Vt Lis ct0.'c A L Afie
City: o-� i i Lf' Lr' Y V, n. " `State: t C
Address: �� r�'� Dap c.ANd LA l: < Cen
City: IPi it -C .L State: FL
Zip Code: 794q H Fax:
Phone No. E-
Zip Code: 3tie1,; 1 Fax:
Phone No Cg I - 4.f 2- $ t ul
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail "TM sre,.,✓1 c• t r.nG C,v,q C
State or County License F_ C , 3 o 0 41 H 14 3
from the Owner listed above)
If value of construction is 2500 or more; a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
State:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY
Name: _
Address:
City:
Zip:
Phone:
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult 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 the jobsite before the first inspection. If you intend to obtain..financing, consult
with lender or an attornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF T-Z,
Sworn tp (or affirmed) and subscribed before me of
thiso'i-`i day of 20 Z I by
Physical Presence or Online Notarization
Name of person making statement.
Personally Known OR Produced Identification
Type f Identification Produced
(S6R4tuVe of Notary Public- State of Flo a)
IAMNA INGRAM-RIMING
Commission No. (Seal)'
-
' •=`Al1Y'COA4MISSION#GG275060
.. :,.-
EXPIRES December P. 2022
�''FOF ;° •' Banded Iku Notary Pubttc Undervur(tera
REVIEWS
FRONT
ZONING. ,:
-SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE ,. .
COMPLETED
Rev 5/20/21