HomeMy WebLinkAboutBuilding permit app , updatedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O I2 I Z k Permit Number:
r
U v Building Permit Application
Planning and Development Services s,s
Building and Code Regulation Division Commercial Residential t 1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address:
Property Tax ID #:
Site an Name:crYri.1 `\ Block No.
Project Name: \VnX Oy\
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit —check all that apply:
_Mechanical
_Electric
_Gas Tank
_Plumbing
Total Sq. Ft of ConstructCion:
Cost of Construction:;) J_QdU%�
_Gas Piping
_Sprinklers
_Shutters
_Windows/Doors _Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
City^Q�
Zip Code: Fax:
Phone NoE
Mail:
Fill in
fee
simple
Title Holder on
next page (if different
from
the
Owner
listed above)
• N"j�5c�1�i4iifi\
t l��'- _W
Y: State:
Zip Code: ��sl.2S� Fax:
Phone No ( f�\�i C 1L-(0.(� \t
State or County
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.
SiJPPk4�1fENTAE GQNSTRtJGFIQN EIEN CAUti I�JQRMATbN
-
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 an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consuYt 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
ft
COUNTY OF S} \ Nl,Q\ pt_
Sworn to (or affirmed) and jubscribed before me of <. Physical Presence or Online Notarization
this day ofVitA,��, 201 by
Qo%?et(\
Name of person making statement.
Personally Known ow —_ OR Produced Identification
Type of Identification Produced 'ten
(Signs re of Notary lic-State(9fFlorida) _
•;I;'r,6 LYNDSAY MIJAL
Commission No. �,(�&iq (Seal) g'' COMMISSION RHHWWII
MY
y., p,�€ EXPIRES: June 23. 2024
Bonded Thm Notary Public UndeM'dtero
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21