HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number:
g 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: C g
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Address: gGOy cie ., r Aven,e
Property Tax ID#: 13 0 I - 601- DDyy- ODO- G Lot No.
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Site Plan Name: Block No.
Project Name; (� \■ (/!y (} y
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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/Doors _Pond
_Electric _Plumbing _Sprinklers, _Generator _Roof Pitch
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Total Sq. Ft of Construction: !�O � Sq. Ft.of First Floor:
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Cost of Construction:$ & o �S6$0 —Utilities: —Sewer Septic Building Height:
ea? x �� vs = C is, �c fii �r £--
QIN1lE�3rLES �E � f y " a �C�NTRT£ R � F-
Name Name:
Address: 96oJ I) /"J 11,4,- Company:
City State: FL Address: 1
Zip Code: 399ST Fax: City: State:
Phone No. ?7 2.- S/q- 60 I t E- Zip Code: Fax:
Mail: i� o del a bell J�h . Phone No
Fitt in fee simple Title Holder on next page (if different E-Mail
from the owner listed above) State or County License
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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.
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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 TIT LE 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 any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult 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..lf you intend to obtain financing, consult
�with lender or an attorne before commencin work or recording our Notice of.Commencement.'
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF—
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of 20_Uy
7r W kSIM
Name of person making stateYnent.
Personally Known OR Produced Identification
Type of Identification Produc
va
(Signatu blic-State of to id
,���!; ,, ELLEN VAUG�N
Com s 2 State of Fio��a-N 4� Public
=* *= Commission # GG 270079
39� oeeec My Commission Expires
9btsber 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW . REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 20 21