HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUST BE tiiuno ��aeon�� pLICATION TO BE ACCEPTED
Date: ti IION Permit Number:
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Building Permit Application
tanning 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: �'I `1 Y�(S�l (fit- mil' L►
Property Tax ID#: ^!10 —um-1— OW 19 Lot No.
Site Plan Name: Block No.
Prjoject Name:
2-11700
.a•
New Electrical Meter Second Electrical Meter (Affidavit required)
A�l ditional work to be performed under this permit-check all that apply:
Mechanical —Gas Tank —Gas Piping —Shutters _Windows/Doors _Pond
V Electric _Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction::/ Sq.'Ft.of First Floor:
Cost of Construction:$ o�� � Utilities: _Sewer —Septic Building Height:
Name Hmavj o 1( Name:
Address: Ll Vc to 5+ Company:
City: ((�� rce State: ,-,Address:
Zip Code: �`-t5'vgd Fax: �l City: State:
Phone No. 3Lt�, �5LL 1551l I E- Zip Code: Fax: I
Mai1:--,�Cfl-C-U-1 2-11 G C)- • C-Dnn Phone No
Fill in fee simple Title Holderion next page(if different E-Mail
from the Owner listed above) State or County License
Ifivalue 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.
OF. Ct?NSTi .l1GTi0 LIEN LA iN` RMATIti ;
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 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
with der or an attorney before commencing work or recording our Notice of Commencement.
7 J
ignature of Owner/Lessee/Contractor a Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn o(or affirmed)and,subscribed before me of /PhysicalPresence or Online Notarization
this day of NOV 203- by
=M Vl9 Gl
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of F orida)
Commission No. _,,,_(Seal] ELLEN VAUGH Public
`=tPn °e��.State of Flerida-Notary
mission # GG 270079
� y Cbrrirtfission
Expires
�6trib0t x2,
202022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION- SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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