HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICAB INF MU T BE COMPLETED FOR•APPOCATION TO BE ACCEPTED
Date: Permit Number: �
o .l
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:
1 aar.,'3 _`"' 4.r
RIICSED IMP, @V11�I `filarIN 4R tM
.«.,. w. ......,...+., � .",.,,_m r.�......,.,.�.y« ......__. :..._ M r �.�a._. eM .._N �.� .....� .,„.�..,s,2�":._a«a..x-..2.•aY.n. .,.l.x.x _ ....o. a1H-� ,. +' .�.,$'
Address: (M c'
Property Tax I D#: �� Lot No.
Site Plan Name: Block No.
Project Name:
1 >.�.:w r_,: 1 1, �' ,�„�:eat� 3 _ f "s �� fiti. � �y `, �,,r � � z„ t•a �ga4 1 � } � r� dui S ;"�n� � S; a,�
T tLED DE : IT� C}F WQRK� , � HI3
��iv�s � ,P5«�" � '�*'"`��.����� ;-�1:? t �i 'ir �� '�'`�� I,NIP,� x �.£-'°� �t.•� 5�, �j� '�d .
�v
New Electrical Meter Second Electrical Meter (Affidavit required)
�r.,. ^: 'H �, { 7'u11-1S '� F '�p''t ZQ
'F J "`— -:, jzL ��`1.i
Gf3NSl' UCTtQI I`kFp tN ATIQN ' f�
-ems:,"nY,
Additional work to be performed under this permit—check all that apply: r
_Mechanical _Gas Tank _Gas Piping _Shutters wtohe Pond
Electric :`3 Plumbing-:-a: -�___Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construet'iori' • "" Sq. Ft. of First Floor:
1.
Cost of Construction �$�:e�.,•,�:, " ` Utilities: _Sewer _Septic Building Height:
® 1%NER ,LESSEE 3 ,'
Ti
Name Name:
Address Company:
City: c State:](jLAddress:
Zip Code: Fax: City: State:
Phone'No. h Zip Code: Fax:
E-Mail: �� Phone No
Fill in feesimple4Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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 . MORTGAGE COMPANY: _NotApplicable �
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 failureto.Record a Notice of Commencement may result in paying twice for
improvements to your property. A Ndtice`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.
c
ignature of Contractor-or-0 r Bui er as applicable
STATE OF FLORIDA o
COUNTY OF St. Lucie
Swor o(or affir )and subscribed bef me of Physical Presence or Online Notarization
this day of 20 .:q by
Name of pe on making statement.
rV- m
=-zrr_e7.82
Sof FloridaPersonally Known OR Produced Identification 41BB5Type Id ification ProducedTg 11.2023otary Assn._
(Signatu otary Public-State of Florida))
—Rosa Barajas
Commission Not ipubllc
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION '-, SEATLJRTLE•' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev0/12/21
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 n.on-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 p J 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.
Sign ure of Owner/Lessee/Con or as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor (or affirmed)a d subscribed before me of Physical Presence or Online Notarization
this _day of C 2%by
Name of person making statement. S
Personally Known OR Produce tifica
Type of Identificatio roduced
(Signature of Notary Public-State of Florida)
Commissio Qrk%11YP
:SUGHN
tate of Florida Notary public
Commission # GG 270079
%;yg�iFi�gPX� My Commission Expires
REVIEWS FRONT ZONING SS PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE-.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 2 2