HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED
Date:* I jlF I Permit Number: - Io2• D .�D J
RECEIVED
•. _ . . a _ DEC 2 2�21
Building Permit Application
Planning and Development Services St.Luc' County
P milting
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 n P ' FL 1 9
Property Tax ID#: 0; Lot No. ,/
Site Plan Name: -` Block No. `'I
Project Name: Qk_t wvc -
S
"fx £ �•'S i�.E`�T ? �•'. ^ate
^C on cr t---f-c �sF I coo 00 n 1 C) -� -
- S bps u,nk nv�Os , w o Ps; &r P+Vvc-
New Electrical Meter Second Electrical Meter (Affidavit required)
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:$ � r1
-o Pw1— Utilities: _Sewer. '✓S.eptic. Building Height:
W 'Name ` I Name: JaSC_ aILA
10
Address: L a/}-.-oq Li w aR PkcW M Company: SL. P Co rlcc-e�e C_o�F�ucF i1 c
City: J-0(' State: - Address: Sao e Z
Zip Code: L Fax: City: 2 or - N Cr Cc, State: (-
Phone No. '7-7 1 e) 3� 18 Zip Code: 3Y R 3 ( Fax:
E-Mail: Phone No 7'f a a f. $� 1 b
Fill in fee simple Title Holder on next page(if different E-Mail CV\gL(SC•�cy 7-7 vZ �^^Gr �• C �'r"
from the Owner listed above) State or County License Coy^k
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: _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 holderto 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 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 our Notice of Commencement.
Signat f Owner/Les e Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to or affirrn�4Land subscribed'b^ef�r,e me of _Physical Presence or Online Notarization
this ay of e (�. �1 by
A,laed.n
Name of person making state Unt.
Personally Known R uced I entifica ion
Type of[dormtificatinn Produce
(Signature of Notary P lic-State of Florida)
•SpP,Y PUeL, AUDREY B.HUMPHREY
Commission No. (Seal) ,: 1 ;} MY COMMISSION##GG300817
:°s•, ,� :o: EXPIRES:March 6,2023
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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