HomeMy WebLinkAbout Building Permit Application All APPLICABLE N O MUST BE COMPS'"tD FOR APPLICATION TO BE ACCEPTED. y
Date: 12 Permit Number:
RECEIVEg
9Mo d Ourf DEC 0 2021
Q(mm "
P. ,� ~``~" Building Permit Application St Permitting
ry,
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:
PROPOSED IMPROVEMENT LOCATION:Address: g1160. 7yt,,Ifk !OW polle dek6t'+U � + F J Y J� �
7 4_
Property Tax ID#: 35 )5- 1b12-00T J` 600 t Lot No.
Site Plan Name: oe'w fil) a's Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Ili flew oN 65ikt1'7,0 C7a /e �(
d VAMI
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
,Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric X Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: /� CC Sq. Ft.of First Floor:
Cost of Construction:$ -( �c3 �-� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name <TI W-, ' (2e0- Name: Q0T !Meg_
Address:. 1400 g, O100 DPI Ve Company: +h -14
City: JpyV_W aAdd State: Address: ' UL 14 h
Zip Code:-12jdl157 Fax: City: O aim &A-0- State:
Phone No. q75-&60 -$52g E- Zip Code: �1III Fax:
Mail: 1 0-11AA51 12teCe9 P'44, 1 •COm Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License (2 - I42 911
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.
SUPPLEMENTAL ",WX
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 ja 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 al'I 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 your Notice of Commencement.
�'-Signatut6-6f'Co6tractoi—or=OWner'B6iTdi!r as applicable
STATE OF FLORIDA(�L�.2,
COUNTY OF etc
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
thisl4l day of 2qJL by
Name of person making statement.
Personally Known OR Produced Identification
Type of Id tification Produced
(Si nat of Notary Public-St&of Florida) CHRISTINEYOW
N N-'YC�
state of Florida
Notary Public
187029
Commission No. (Seal) cornrnission 2 GG
N..y Co
r1rn.Expires Apt 26.2022
Lgi.fi;;l Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1 12/21