HomeMy WebLinkAboutPermit App 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: a
_ 03 Gnove %
Property Tax I D #: RIO _ 0 o n,3 - ®d 0 Lot No. J
Site Plan Name: `A Block No.
Project Name: ( "r�
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
T Gas Tank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ - % y 1
_ Gas Piping
— Sprinklers
Ahutters Windows/Doors Pond
_,-, Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
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Name i e` r
Name A7 'C
Address: r•'S" �'�ve �D �.
Company. COA}., t Ye"/ 01-FA /OFF
City; State: 112/
_ c� '
Address: 3 6 if/ Lv 'e
Zip Code: 3LJ2n a Fax: ,�I _
City: fl egeee State:,
Phone No._ Y 14r b LZ r,1l -7 72 2- 9YV '9/ 4-
Zip Code: 3119 yd _ Fax: 7 Vd 1--4f
E-Mail: A
Phone No ?- �Z6 a?/
E-Mail f0 Q �d� errl
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
5tate or County License - a S/S"Qd'
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.
DESIGNER/ENGINEER
�, Not Applicable
ble
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGj
Name:_
Address:
City:
Zip:
COMPANY: -�V Not Applicable
Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
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 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 1 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 your intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
as Agent for Owner Signature of �Contr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFF _ COUNTY OF Zb a
Sworn to (or affirmed) and subscribed before me of
,,"" Physical Presence r Online Notarization
this ( _ day day of 202 f by
Name of person making statement.
Personally Known OR Produced Identification
Type of Ide ficati n
Produced
re of Notary Public -
Commission No. _;� ��: %`. BARBARt��h l,�0
,a_ Public - f Florida
F' Commission 9 GG 237991
m- txotr95 Jul 11, 2022
REVIEWS I rR5WT-- —P'O—N—IN G
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Sw� to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
� this , day of IV `V 20291' by
Name of person making statement.
Personally Known OR Produced Identification
Type of IdentMcation
Produced
(Signature of .Notary ublic- State of Florida )
SUPERVISOR I PLANS
REVIEW REVIEW
BARBARA MILILLO
Public -
ission # GG 237991
IEPAITURrkLL73I2 MANGROVE
REVIEW