HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: EGEIVED Permit Number: �I
Or.L.CUC�QE NOV g 2 101 NOV 12 Z0 l
r "'R:. rmitt)n9 PePartm«:•,
St.
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Permitting
9...;' ..: ,.;wA+-a.•�.- y.4 Building Permit Application j
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (77Z) 462-1578 i
PERMIT APPLICATION FOR: �� MS4, q
Address:_ �a'%,S F_ arboo:f2M-t_e
Property Tax ID#: 1�-50 Qc0 'lb Lot No.
Site Plan Name: Block No.
Project Name:
av iS�-In S tl n J_e z� Fib )Q CC I I ,.
I
ew Electrical Meter Second Electrical Meter (Affidavit requireJd)
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 --i Pitch
Total Sq. Ft of Construction: 2CIt,' S-0 -,l- Sq. Ft. of First Floor:
Cost of Construction:$ 7 G GG . G G Utilities: _Sewer _Septic Building Height:
,i � .
MR —
01
Name -poccl en e b)}j Name:
Address:(-,'IT L— A-h Company:
City: XQ,*A 4- G[4 G, L State:)� Address: I
Zip Code: �'/ qS Z Fax. City: I State:
Phone No. '77Z_-- S_79— (XYk Zip Code: Fax:
E-Mail: W(°iWz (G✓c14C/. C�%' � Phone No
Fill in fee simple Title Holder on next page (if different E-Mail _
from the Owner listed above) State or County License
I
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.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF ( ,�—� WC.P/1 /Physical
Sworn to(or affirm ) an subscribed before me of Presence or Online Notarization
this 1_D ay of �� 20 al by
Name of person making statement.
v
Personally Known OR Prod ed Identification
Type of Id ntification Produced r( (1 f
(Signature of Notary lic-State of FI � P /, ELLEN VAUGHN
tP' uB
� State of Florida-Notary Public
Commission No. Commission # GG 270079
My Commission Expires
Getober 22 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21
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