HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST'BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date i_ Z Permit Number: -� d Do
.95U: en ,-
(D
13611diing Permit it Application
Planning and Development Services
Building and Code Regulation Division Commercial -- Residential �
2300 Virginia Avenue,fort Pierce Fl.34982
Phone; (772)462-1.553 Fax: (772)462-1.578 CBDG Funding
PER MIT APPLICATION FOR; � vprL C
NN
•em.,,y mr,(,Ks w u ,�, F .:• .-urx ,z.._Y ,
on
',2.. M. .1..4: ty_i4 - -•:�L".:
-t ..... .•...i
Address. ti�� � J(�Cs�. �Y vi if�R{�p e 11-�� .
Property Tax IA#: �� �'� 01;� Lot No. �
Site Plan Name: - Block No.
Project Name: �
DE`f 0 ILED DESCRIPTION OF WQIc
RK;.
-- - -
6 zonfc Ginjctr4-�
New Electrical Meter Second Electrical Meter (Affidavit required)
CONST1iUCT1QN INFORI1ilATit)N:
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:
� W'•�.mpz�s ar#'-4r v'^Rna.c.,�„e^• tLC•r yya. .,w+. r ;c 2 n y r. -•:c• � s 'a.aa S-�ir»;t ze•.rsc.„Kr .vs', � ,�, Y r �!c �
a '��w ''r-�- JyC
:1CS 3•.� I L`�" �. fir~ <.h ' J _ ;hctw: .:a$; .1i':OAr'S''". '.-:7'r''O, f 's �`«x I <.4.. - I N
Name
Address: Company: a
City: `'-� RI y I;,.E=!� State: Address;
Zip Code: Fax: City: -R 244U State:
Phone No.`1:12. 9:1 l L)u? E- Zip Code- Z Fax:
Mail: Phone No 1-12.$57,_G.Cnq
Fill in fee simple Title Holder on next page (if different E-Mail O 4 4c ,Ca(- `
from the owner listed above) State or County Licensee AZ �
If value of construction is 2500 or more,a RECORDED(notice of commencement is required.
If value of H"C is$7,500 or more,a RECORDED Notice of commencement is required.
^rUE "0 i ;,Y10:_ 'P "ca. i e�1
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY, Not Applicable
Name: Name:
Address: Address:
City: State: City: - State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: —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 exemptfrom 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.
i
' atom-of O r/Less-e/Contractor as Agent for Owner
STATE OF FLOg7A
COUNTY OF -LULL- C0u(l_
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this±L day of &Yd !1e.V ,2021 by
Name of person making statement. j
Personally Known •�/ OR Produced Identification \ PRPExpires
�
Type of Identification Produced _� 10/15/2025
= Scott tt
(Signature of Notary Public State of Flo da) 4
Q My Commission \
H
��� y,� � H 186875
Commission Na. (Seal) '% , 0�,�`
REVIEWS' FRONT ZONING . SUPERVISOR PLANS VEGETATION S-EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/70771
i