HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /�l� 2: 2 y� Permit Number: .
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n- µ 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: yZiOA S / .�U�� �1� `'D F��F.I�CrE F.l• 3��1'`J �i
Property Tax ID#:�'y33-S"b 'b/1p5'5= D 19Z? t Lot No. f
Site Plan-Name: 1 '�'{lS � �/✓G G.��, /� ��• �1r. Block No.
Project Name: �1�t'1VAcy F,6MeE
gilt Z4 L L.
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/D'oors _Pond
Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft.of Construction: Sq. Ft�of First Floor:
Cost of Construction:$�SQ. Utilities: _Sewer _Septic Building Height:
Name ON D l' 7Name:
Address: ?Agj s'r,40WO47/Y.7OXOr /A-"/ mpany:
City: 01 1fi;gear state:lex Adress:
Zip Code: Fax: City: State:
Phone NoUZ`f FT a-n$r 7 E- Zip Coder Fax:
Mail: Phone No
Fill in fee simple.Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
ElIvalue ofconstruction is 2500 or more,a RECORDED Notice of Commencement is required.
ue of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: I_Not Applicable
Name: Name:
Address: Address:
City: Stater City: . i 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 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 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.p6mmencipif work or recording our Notice of Commencement.
P
Sigr}�£ure of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA �� � ��t�d
COUNTY OF A
Sworn to(or affirmed)and subscribed before me of hysical Presence or Online Notarization
this day of kskj 20_,!�Aby
:3mme05
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced 5!1—Ti a
(Signature of Notary P blic-State of Florida) ELLEN VAUGH N
J=o`P State of Florida-Notary Public
Commission No. G\ (Seal) :* *_ Commission # GG 270079
=9 oQ IVIy Commission Expires
October 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
RECEIVED
DATE
- COMPLETED
Rev 2 21