HomeMy WebLinkAboutBuilding Permit Package All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: Permit Number: 1 t
Mama. RECEIVED
Building Permit Application OCT 14 2021
Planning and Development Services St.LucItR6bnty
Building and Code Regulation Division Commercial Residential Pe fitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMITAPPLICATION FOR:
Address: T oo
Property Tax ID#: Lot No.. ZC
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 _Pond
Electric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Z Z Utilities: —Sewer _Septic Building Height:
Name ���'.nCs('� 0C�Q \ a) Name:
Address: � TC.MP �- Company: 1C T��_
city: '�7��rr`�_ State:�L Address: G�� I� AVe.
Zip Code:Z��Fax: City: ,cxz � State:
Phone No. E- Zip Code: �Z CtS� Fax:,
�)y 5�—es `
Mail: Phone No� �!5!�
Fill in fee simple Title Holder on next page (if different E-Mail 'A.CQna
from the Owner listed above) State or County License 1�1
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.
LEM N S CTtt gRAWA-MiN
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 Commencement.
J9
Signature ofrOwner/Lessee/Contractor as gent for Owner
STATE OF FLORIDA
COUNTY OF 3k. LS-xC`A e
Sworn to(or affirmed)and subscribed before me of _ZPhysical Presence or Online Notarization
this day of��`` 11 S,20—
Z—\by
Name of person making/statement.
Personally Known ✓ OR Produced Identification
Typ9lpf Id ntification .roduced
r
r(Siare of Notary Public-State of Florida) ; RISTINAONTIVEROS
ion No. (Seal) *; *: MY COMMISSION#HH103829
EXPIRES:March 11,2025
Bond edThruNotM Public Underwrkere
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
PLANNING& DEVELOPMENT SERVICES.DEPARTMENT
Building& Code Regulations Division
2300 VIRGIMA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 RECEIVED
FILLED LAND AFFIDAVIT 0 C T 14 2021
.ST-. Lucie county, Permitting
J
I, the undersigned, am the owner of the following described property,
C k(- .
(Parcel I #/Legal descriptio dress)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community .WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
.. 1'J. rQ
Prope ty Owner Name(Please Pr' )
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OFF 120
BY WHO IS PERSONALLY KNOWN TOME a OR WHO HAS
PRODUCED AS IDENTIFICATION.
LaIrAE 6 F NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
CRISTINA ONTIVEROS
SLCPDSD Revised04/11/2011 *; MY COMMISSION#HH103829
iaoc EXPIRES:March 11,2025
f P'F(��`�; Bonded Thru Notary Pub9c Undenvritere
RECEIVED
OCT 14 2021
ST. Lucie County, Permitting