HomeMy WebLinkAboutfilled lands affidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
14'to - 311- Con -000 -& 31 �q 1-6mmor\a P`cl
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
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Property Owner Name (Pleas Print)
i 1_]� lo�lQ 2� D
opert Signature Date
STATE OF FLORIDA, COUNTY OF u,
15
ACKNOWLEDGED BEFORE METHIS � DAYOF�4�iU���� ,20
(
BY E% w"rI�)CLn `j] e- WHO IS PERSONALLY KNOWN TO ME Nj OR WHO HAS
PRODUCED
IC
GC1 1(Z"a8 ' COMMISSION NUMBER
AS IDENTIFICATION.
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TYPE OR PRINT NOTARY
(SEAL)
SLCPDSD Revised 04/11 /20 11 hR $ARINACfREH
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EXPIRES: YO7nW8, 2021
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
1,j- kr
u 7wrow7T F' tl� -- 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 1 Li ?)o - 2) (1 - c c)1 o - cm, c - Lot No -
Site PlanName: \_;, �,� 1��\C 1a�r t'£CC [1Ji.`.,uJAO ( r b {_ Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter P
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
Mechanical Gas Tank _ Gas Piping Shutters `Windows/Doors
Electric
lumbing _Sprinklers _Generator -Roof
Total Sq. Ft of Construction: Iy 16. Sq. Ft. of First Floor:
Cost of Construction: $ 1 v Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
Namecu XV 1. Ct-if L•.
CONTRACTOR:
Name
Pond
Pitch
Address: �i C Company��n
City: ,, E '- State: Address: ��S.llal 1 � ►Yr vY�Ga^ t�
Zip Code- LkQSl -6 Fax: -1� 33 �- 3ri�' City: iC c� Stater.
Phone No. �7� - ��a3 '3 E- Zip Code: �lLi�{Ct Fax -3cIo
,L�k- 1�'r r ►� _ - C r -� r\ 'Phone No'-M. -3�� - D-3 J
Fill in fee simple Title Holder on next page (if different E-Mail C,� CL o[��Lu<« OCU�i(" C'-
from the Owner listed above) State or County License ' (= l JC^ t_j C
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNEE:/ENGINEER:
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
I Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
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. If you intend to obtain financing, consult
-arth.lender or an attorney before commencing work or recording our Notice of Commencement.
re of Own eKessee/Contractbr-ks�Agent for Owner
STATE OF FLORIDA
COUNTY OF 1-LL,
Swo n j9 (or affirms ?d) and subscribed before me of Physical Presence or _ Online Notarization
this day of 20.• by
Name of person making statement.
Personally Known �O OR Produced Identification
Type of Identification Produced_ `
(Signature of Notary Public- State of Florida)
Commission No. Oka' (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZWKIYAM
ZONING
REVIEW
SABRINABLULER
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MY COMMISSION # GG 163728
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EXPIRES: Deceffftr8, 2021
Bonded Thin Notary Public Und wbm
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
REVIEW
REVIEW
REVIEW REVIEW
MANGROVE
REVIEW
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