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HomeMy WebLinkAboutBuilding Permit ApplicationJ All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: O' c�J' �l Permit Number: o Uo C UQ 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 PERMIT APPLICATION FOR:. _5W� MImo!,N C7, e?,00L Nckoap> - _ Address:JIL%� 3q?,so a, of ' olo� +` Lot No. Property Tax ID #: 1•I Site Plan Name: Block No. Project Name.: =00 r, K •.' R New Electrical Meter Second Electrical Meter (Affidavit required) r Additional work to be performed under this permit — check all that apply: Mechanical Gas Tank —Gas Piping _ Shutters -Windows/Doors _ Pond &C Electric X Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction:Sq. Ft. of First Floor: Cost of Construction: $ ?) (r©!!0 Utilities: —Sewer _Septic Building Height: ISO cJ IrGU l70 T4A L, D APD Name: G{IM 1 � � ..,� U � �o S Name Address: glLf( N1,1 1` UV)vI r Company:',:.: 1 City: ` <) `c�' S� Lid ,c,� �i State: 74— Address.:, 33J'.3, --5DU'E'�A.� a'�J ��3 tJ. �'r' Zip Code: 34q g Fax: _City—/e�j� (?CJt t i3i�G� State: L Phone No. i �VIIA of ��mmy' `: 3�J�1trJJ Fax: ctlgjcy �o r X E-Mail:, ` /1 jm Fill in fee simple Title Holder on ne 1 �` , `�a�`�� c5 tic-'I42-4 � I License ��G OS / `� County from the Owner listed above) vent is required. If value of construction is 2500 or more pl �� l q If value of HAVC is $7,500 or more, a RI is required. AML low DESIGNER/ENGINEER: Not Applicable AGE COMPANY: -Not Applicable MORTGAGE 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 installatio*n 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. on of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work In consideration 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 your Notice of Commencement. S� IJIA Signature-WON7vner/ Lessee/Contractor as Agent for Owner STATE OF FLO COUNTY OF Sworn �t_or affirmed) and subscribed before me of LI-IlPhysical Presence or Online Notarization ; t o' this day of _Ak*l 4 aL _ 202A by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced, (Signature of Notary ll�u—bl'itj-1�4k- RNIMMII V Y �&02k� Notary Publiq of Fforida Commission No. _ — I - - T Sv64 a gn win My Comm" m GG 345514 I It"V Expires 0SM612023 REVIEWS FRONT COUNTER ZONING REVIEW' SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA -TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED Rev 5 2 A