HomeMy WebLinkAboutBuilding Permit Application Lfte2 .
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a 0 g �� Permit Number:
V.�.CIC 011E � 4
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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
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PERMIT APPLICATION FOR: , �f P'4
Address: p !�! f�FJT� Ct✓n�e% �I"oQ�';"�' � '.�� -, '
Site Plan Name: Block No.
Project Name: &4io •-Pn/Z
EIEIMIWMO�=�ffi`
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: Cod Sq. Ft. of First Floor:
Cost of Construction: $- I� � Utilities: Sewer Septic Building Height:
= _ - -
3'zi'sr rF9- Name: �e�l�ca✓p' - —
Address: ,` M 612 e nl 71'p �' Company:
City: O/L4 L ; Z.y State: L, Address:
Zip Code: Fax:Fax: City: State:
Phone No. �_�(�j SJ— 6 0 // Zip Code: Fax:
E-Mail: elty h,Q S S'rep- i;z 1 Q C6�►rli7i, ��� 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.
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable,
Name: Name:
Address: Address: 1
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.
o-
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 Inon-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 it the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I der or an attorney before commencing work or recording our Notice of Commencement.
Ae
fi&ature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY-OF .S -(ALk
Sworn to Lor affirmed) an subscribed before me of '�Physical Presence or Online Notarization
this y of 20;)_`by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produ
(Signature of Notary Public-State of FI ) I
Commission No. o``;RVd��,, (SeapLLEN VAUGHN
_r 4�State of Florida-Notary Public
*c Commission # GG 270079
My Commission Expires
llllll`- OS Z2,,.2022 1
1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21