HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED 1
Date: Permit Number:
ff - •' '=` ° 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:
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Address: `3oc?2 2-6ad R)RA PiscV_U . VL 3q_QFI
Property Tax ID#: �J� ' v� � 00dy "' C)oc:> Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ '` oo •61, Utilities: —Sewer —Septic Building Height:
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Name )i K_ .,, niS- Name: ' r
Address: 3u c) Lanv_ C6'
1 _Company: noci IsLutdLet
City: ?I,OWf - FL State: Address:_ +9 Q ,!- Me_ y&Ad
Zip Code: 3LI94KI Fax: City: Q&IPiE2CF_ State:
Phone No. `179`5`29-35672. E- Zip Code: 3y98) Fax:
Mail: 54A-10i 3 @ hC+Mlt,l - e Phone'No 77'•579.3'5-&!L
Fill in fee simple Title Holder on next page (if different E-Mail 5-}0451 3 @ ha-�mPr►
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.
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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 SIMPLJE TITLE HOLDER: _Not Applicable BONDING COMPANY: vAot Applicable
Name: i S Name:
Address: AME Ed Address:
City: i 9 L 3WRI City:
Zip: Phone: 77_'2-579-'39'&Z 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, ] 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 posted on-the jobsite before the first inspection. If you intend to obtain financing, consult
with lerideror an attorne "before Cornmencin vvork'or recording our Notice of Commencement.
Signature of O r/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA S ���
COUNTY OF c
Swo (or affir ed)and subscribed before me of 4'hysical Presence or Online Notarization
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this day of 20,—A by
Name of person making tement.
Personally Known OR Produced Identification
Type of Identification Produced 2
(Signature of Notary Public-Sta e Flori
Commission No. (Seal) �F :ate°.` cj�ir�°f FAN Vq
°''d ` �jY CO 77Oonda.Note yN
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REVIEWS FRONT ZONING SUPERVISOR PLANS GETATION . SEA TURTLE,'. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED%
DATE
COMPLETED
Rev 5/20/21