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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: llo ILL�l�ll r RECEIVED O p_ ra D Building Permit Application Nov o 2 2021 Planning and Development Services St PermitCounty ng my 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: ACC PROPOSED IMP ROVEMENT'LOCATION Address: 1 �C s Property Tax ID#: 13d O Le k - ' ©l� �' Ono • � Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION"OF WORK: New Electrical Meter Second Electrical Meter (Affidavit required) CONSTR,UGTION INFORMATION 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:$ Utilities: —Sewer _Septic Building Height: OWNER/LESSEE:- CONTRACTOR:' Name C-f"qC_`e c.-� a pe e(I Name: 4 Address �_ IK Ct company: rt` 71) City: State: `_ ' Address• 1 Zip Code: �� �� Fax: City: d'rry C'i,crs'2 State: L Phone No. E- Zip Code:. Fax: Mail: Phone No 7 Fill in fee simple Title Holder on next page(if different E-Mail PC— co from the Owner listed above) State or County License C'"q-- f 2 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. Upi`L;N'J[NTAt� C0NSTfyUCT1QN 11 .N 1 1 11N�C3FZIV10 fl( N:'' F .DESIGNCR/ENGINEER: _ Not Applitable _ MORTGAGE COMPANY: -� Not Applicable Nanici WOW: rXddre�ss: � _ Adtlt'oss City: State: City: - -State: i.zip: . Phone Zip: Phone am-- --— j 'FEE'SIMPLE`TITLE HOLDER: Not Apltlkable BONDING COMPANY: Not Applicable l:iVan�e; _ Nanu�: f�..Address: Address: I rt}c' _. City: - - Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made.to obtain n permit to do the work and instaliationas indicated. I certif},that no work or installation has Commenced prior to the Issuance of;,]permit: St i.ueie.%ounty makes no representation that Is Prantlng a permit wilLauthorize'the permit holder to build the subject structure 1.i h+ch coafiicts with any applicable Homeowners Associ%on rules;:bylaws or and covenants that may restrict or prohibit such structure,Please.consu Iwrth your.Homeowners Association.and review your.deed for any restrictions.whicli may,�pply. Inconsideration of:the granting of this requested permit,1 do hereby agree,that I will;in all respects,perform the work- in accord ance.withahe approved plans,the Florida Building Codes and'StAucie County Aniendments. The.following building{permit applications arty exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,wails;signs,screen rooms and accessory uses toanothernon-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 trust be.recorded in-the public records of St. Lucie unty.:an. osted on the jobsitr before'the first.inspectionAf you intend to obtain financing,gonsult with I .n er o a ° ttorney before commencing work:or recording,your.Notice of Commencement: t Ste...nature of bwqmY.Y. e C tractor aB Agent for.Owner STATE.OF FLORIDA COUNTY OF <.::�t V LC\?' I Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization this2a day of. —�20_by { Rc' CAL I\GS c�V% Name of person malting/statement-. Personally Known ✓ OR produced identification Type entification.Prooduceed (Signature of Notory.Public__State of Florida) i QQ � Commission No. -C 2sc :5 1(seal) ::��. AAIAAI�F ADAMS i �? iAY coMMISSION fI GG 259439 : EXPIRES:September 17i 2022 '•'ocF4�. Bond tt+i1 WNat2rylPubL'cUadCrWrt1BIE: REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE ? COUNTER REVIEW REVIEW REVIi:W REVIEW REVIEW REVIEW DATE: ' RECEIVED DATE + { COMPLETED ev 20/2 . I I 1 i