HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �I�/�® 000
OCT 012021
Building Permit Application
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Planning and Development Services p,r►flifjitn,�
Building and Code Regulation Division Commercial Residential v
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: q j e1411,4 dl
Property Tax ID#: '` qnz- 6C)2i"6l ?-3-CQ0 't 9 Lot No. 7
Site Plan Name: ??itW Block No,/
Project Name: &
DETAILED DESCRIPTION OF WORK:
RP A i&dAdr X,f' A LwZL4 e- OC
New Electrical Meter Second Electrical Meter (Affidavit requiried)
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CONSTRUCTION]N FORMATION:
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 Ko'of Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height: tl5 �
OWNERAESSEE: CONTRACTOR,
Name Name:
Address: t ak\il04T\Tr Company:
City:.11\1 R' eub- ( State: Address:
Zip Code: 3 Fax: City: State:
Phone 1No.l/ '�-}, �� ;o'm r- E- Zip Code: Fax:
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Mail: r,a2C•C - �c�d`L�^ R I as R 6� mo, cow) 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,S00 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:, l
j.
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 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 attorney before commencing work or recording our Notice of it,
M�` (� q ' HEATHER BURFORD
`� ;20"° °��:;State of Florida Notary Public
Signature of Owner/Lessee tractor as Agent for Owner f �= Commission # GG 183217
o- My commission Expires
a;
STATE OF FLORIDA 9��� ! February og, 2022
COUNTY OFF
Sworn to(or affirm ) subscribed before me of P ical Presence or Online Notarization
this a,day of 20)2 by
Name of person making statement.
Personally Known OR Produced Identific pion
Type of Ide tification Pro uced
(Sig re of Notary Public-State of Florida) VMENNEA FINLEiTER
�ptAR R s
Commission No. 9#101"1 (Seal) oQ °� Notary Public
0 o State of Florida
= Comm#HH174135
SINCE j9�� Expires 9/9/2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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