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HomeMy WebLinkAboutBuilding Permit Application .All APPLICABLE:INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: !Vim" �2�2� Permit Number: t.2 Uo - 111.5 __- t 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: (772)462-1578 CBDG Funding PERMIT APPLICATION FOR: Address: o f M►bg ©f L Property Tax ID#: 151 QW ID Lot No.� Site Plan Name: Block No. Project Name: 'i F rlf7t 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: I Sq. Ft.of First Floor: Cost of Construction:$ �(� Utilities: —Sewer _Septic Building Height: Name �� Name: Address: Company: City: M4 1e4toz, State: Address- Lip Code: v ( Fa : City: State: f Phone No. '"o E- Zip Code: Fax: Z-1 ILL Mail`. 51L}h d 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$7,500 or more,a RECORDED Notice of Commencement is required. A I 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 j 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 r Notice of Commencement must be r!ei d in the public records of St: Lucie County and pos the job before the first inspection. If you in en tain financing,consult with lender or an at ne b e commencin wo k or recordin our Notice of om cement. ignature of Owner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA i COUNTY OF TYNc�tr.r, Sworn to(or affirmed)and subscribed before me of V P iysical Presence o Online Notarization thisrW day of DCJ�bb� 203k by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced Produced(Signature of N ary Public-State of Florida) �� > , Lorry CDD�9ef o,; EN VAUG YN Commission No. (Seal) ��; ,r+: C�iailrl, a � _#=� " Nlorida-Not'ar P bl f 'ati p��a�{ Nov. =* sion #GG 2700Pdl �fEU�o tlG76 N4Y � ice• t,�,�qq , n0gpp 0mission'Expir s � UisuL9 � Ar`ii'ii 9`dfllf� / dbar 22, 2022�b I REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW EVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev 5/20/21