HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPL TE❑ �R APPLICATION TO BE ACCEPTED 1 ' I
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Date: Permit Number: v 11
Nov 0 8 2021
uO F—L f ORE, St.Lucie County
O . r Permitting
• ' �" .` Building Permit Application
Planning and Developmeht Services
Building and Code Regulation Division Commercial Residential '
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)-462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: A Cie
51
No
Address:
Property Tax ID#: 3 �� "y QyoV Lot No.
Site Plan Name: `_' Block No.
Project Name:
Mm__ 11
INSTALC 55 n .S'►- IGH CHAnQ Ll^JK FEENC= C-ONNECTtO
TD OrIC S' H 101H ODuRLE G PJE C-0NtilEUrE-D TO 3 0" C, AC_vAnllZED
5" H iGH C ra[Ainl L1 J1,!K FFfJCE, FENI F, wlCC ROM ACOnIC 0Pi=M -. \- -
New Electrical Meter Second Electrical Meter (Affidavit CAR( M-r cent N&P required) SIDE, Of: HOME.
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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: $ clso 00 Utilities: Sewer Septic Building Height:
— i ,
Name TEPEE AH G iyi,,1 ,S Name:
Address: C109 C()Wr41 T_ AVENUE Company:-
City: POR7 ST LLt C 167 State:E�, Address:
Zip Code: Fax: City: State:
Phone No. C SH -(,OFC-`703�1 Zip Code: Fax:
E-Mail:__�S-tY 123--l®a fv1C i i{• CU r-N 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. I
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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 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 commencing work or recording our Notice of Commencement.
Signa re of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and u s ribe efore me of cal Presence or Online Notarization
this day of 20�` (by.
5e fe I`n1 0.,h Ci'UIIAI
Name of person making statement.
*7�
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Nola
EN AUGHN
�`,a�al` B��;state of FlonOa-Notar Pubft
Commission No. a - missio ft�G
Ires
079
My Commission®��
C)ateber 22,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER ' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21