HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO 7UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_.......t.�.. .� CA d p� Permit Number:
RECENED
"I UF C�
OCT 2 9 2021
8•" — St.Lucie CountyBuildin Permit Application
Permitting
Planning and Development Services
Building and Code Regulation Division COm] mef Cial Residential
2300 Virginia Avenue;Fort Pierce FL 34982
:. Phone:(772)462-1S53 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Address Fso��tk A.'t
Property Tax1l)#: Lot No.
a Site Pln Name: l'� \ 6 V G J UO�
', j Block-No.
Project Name: LVn
i00 ylC� d SaqN
—� _�CLL0< pa-aI Qe A)-�
New Electrical Meter ace h"Iflecond.Electrical Meter (Affidavit required)
KNim-
,'Additional work to be performed under this permit-check all that apply:
Mechanical r ,: _Gas Tank: _Gas Piping' Shutters _Windows/Doors _Pond
.i ectric _Plumbing _Sprinklers ^Generator _Roof Pitch
'Total Sq.,Ft of,Construction: Sq. Ft.of First Floor:
Cost ofConstruction:$ 4���C�. Utilities: . Sewer _Septic Building Height:
'Name iL.L l yS P�Lu l Ll. Name: Ct� & riAf
Address: 5^4 �✓n �l-:;�j Company: Far'-soni LIQ.cA-dtc LcaT v(1,
City: -q-0 A,T ?1 State: Address; -(� � hS 0
�P/1 C . L-
Zip'Code: 3'�CS �. Fax: City: AIQLAD ��1PhC State:--E-
Phone No. (Ll D��' (970?5 Zip Code: fax: is
.E-Mail: �' `,:•, t P,ho'ne>No '1Z - +1jBC� .
Fill in fee simple Title.Holder,wn.64 page.(if different E-Mail 2A c,n )a44E'fY LC*C_o4/t 'C3''n 1 r, G—t--i
from the Owner listed above) State or County License 13t Q 59
If value of construction is 2500 or more,a"RECOt tO k9tice-of.'Comniencement,is required..r
if Value of HAVC.is$7,500 or more,a RECdRDED Notice,of Commencement�s required
. _
r
DESIGNER/ENGINEER;, :. •.:y;i,;s:;;;.Not-.Appiic�bte `1VfORTGAGECOMPANY: Not Applicable
_Name: _ :z: ? t ,_; a ,.•.
Name:
Address: Address:
City:_ State: City: State....
Zip. Phone ;.,. . :r Zip Phone-
FEE-5IMPLE-TITLE'HJd[bI1fk: 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 install _ion has—commenced.prior to the issuance of a permit. :. .
St. wcie.County mak s,,�.r �a—tstign that is granting a permitwil{authorize the permit holder to build the subject structure
whiff h is ih con hct With=n•, _ =n1e"Hbehe'Owners Association rules bylaws or and covenants that may restrict or prohibit such
structure.Please consult.A..irn_fc-r Fiome"Owners Association and review your deed for any restrictions-whtch may apply.
'irr consideration of the oranur. �f tnis requested permit,I do hereby agree that I will,in all respects,perform the work
in.pccordance with the 3ppr--.a pian_,the Florida Building Codes and St.Lucie County Amendments.
The following building permit_Yr.ic -.:ms are exempt from undergoing a full coricurrency review:room additions,
accessory structur s,,�linii iir �cs,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 is your.property. A Notice of Commencement must be recorded in the public records of St_
Lucie County .and —st" on i:he jobsite before the first inspection.If you intend to obtain financing, consult_
with lender c,- commencing work.or.recording your-Notice of Corrrmenceme.nt. '
`�u ` J.
Signature of chviler/__: -_. _ rtr.Gtor_�agent for Owner
STATE OF FLORIDA r
,COUNTY OF _�f. • ice e,
Swor _(or 3ttir Za t r,�__ =_r:o- bef re me of �h�sic31 Presence or Online Notarization
this day o,
1.
_
Name of person.mai ' o s_at m nt.
Personally Known OR Produced Identification'
Tvpe a`Identification d_. -
_..
(Signature of No y Pc^Go-gate of Florid ).
Commission No.; (Seal) �RY �-J AUDREYB:HUMPHREY
&�:
MY COMM1SSfON Ik G 817 \
EXPIRES:March 6,.2023
. lets
,...:•e:
Bonded Thm Notary Public Uap.L�
REVIEWS', FRONT ZONING' SUPERVISOR. . .PLANS VEGETATION;,. SEA;TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED',',*