HomeMy WebLinkAboutBUILDING PERMIT APPLICATION i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
•a,Q �.,� Permit Number: l 10 (A
Date: 1
RECEIVED
E UOM _
r DEC Iq2021
Y nTY10. D:ra.•...-�,.� Building Permit Application
St.Lucie County
Permitting
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: .
Address: I ?
�T
Property Tax ID#: 2—:2-11 Z O U G l _ 0®Q Lot No.
Site Plan Name: Block No.
Project Name:
o
Affidavit re wired
(3 b �7-' 'Z'z�.D k J "Q-0*JCTQ_�
New Electrical Meter _Second Electrical Meter ( q )
-
Additional work to be performed under this permit-check all that apply:
_Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
XElectric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 190 -� Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer Septic Building Height:
Name �19r1.� L C� 71- Name:
NA
z I
Address: �'j tq 0-o(lt�t)%u l)1 )12• Company:
City: zv�-1 -9"E��t z Statq�L_ Address:
Zip Code: ",q�Cj q_q Fax: City: State:-
Phone-No. 6 -- 2 '� Zip Code: Fax:
E-Mail: �l n �,� ��(� ZZ Q-Z_6_ eg !�Cti�,Ji&PhoneNo
Fill in fee simple Title bolder 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: _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 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.
L je County and posted on th jobsite before the first inspection. If you intend to obtain financing, consult
with le?rder or an attorne befo commencin work or recording our Notice of Commencement.
Si atubf Owner/ ssee/Contractor as Age4 for Owner
STATE OF FLORIDA
COUNTY OF /
Sword to(or a and subscribed before me of _Physical Presence or Online Notarization
thi ffirm day of zc�� by
r
Name of person making statement.
Personally Known OR Pr d Identification
Type of Identification Pr duced
(Signature of Notary blic-State of FloriclaLf
4;dvP�ya� AUDR MPHREY
Commission No. (Seal) . P=
1 MY COMMISSION ffGG3008?'
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EXPIRES:March 6,2023 ,
Bonded ThruNotarypu i Undert;r;>'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21