HomeMy WebLinkAbout Building Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED
Date: Permit Number: I
O
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
PERMIT APPLICATION FOR:
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Address: 7, �T� S v�P ZL' Zo % :Z 5-
Property Tax ID#: t'v'�_9 - e 0o 0 0 6 J0 ) 0 Lot No.
Site Plan Name: Zlli/!�S Ohq db>/ ���'� n, Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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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: A 3 V 2 Sq. Ft. of First Floor:
Cost of Construction:$ 9 Utilities: Sewer _Septic Building Height:
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Name �/!�� �g r � ,,�� .m Z ,. „�• Name yt_P _ ,, �
Address: •2:a0�_..j s._ Ti Szz✓ n - =CompanyP�i,;�`fs✓
Cit o� ,�pYGe�ry:r zr Lr. -� ��tq+#e: -Address: Zbb
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Zip Cade 3�'�S2 fax ? City: 41 -71 State:
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Phone No .7: ',��.— G t o ? Zip Code: ' '�7 ��7- Fax:
E-Mail• Phone No 720/�7
Fill in fee simple Title Holder on next page(if different E-Mai1�,Q�.,, ?.P�crr•�,7-7 t!if3�A� eta/,cay.•i,
from the Owner listed above) State or County License�31 3�
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.
S�1JRP MENTAL CO TR�U TION�LI LAV%'NROANA'fION:�
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DESIGNER/ENGINEER: ^ Not Applicable MORTGAGE COMPANY: _Not Applicable
Names u�o_ Zf/v Name: -
Address: Address:
City: State: O! � City: State:
Zip: ? Y9y Phone 1S -4�{ Zip: Phone:
FEE SIMPLE TITLE HOLDER: i 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.
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.
Signature. w e ssee/Contractor as Agent for Owner Signat Co actor/License Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF ��' �C► COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Fhysical Presence or Online Notarization Physical P esence or Online Notarization
this 6k day of �J_1,� 5 ,2021p by this day o 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-St ur of Notary Public-Sta of Florida)
�t -1 KELLY DELYALLE
Commission No. �{ �l ( =?4• g��tary Pablic-5tate of F1 rAQO i9f3�Ku Rl d�{o I�
.o� N �lx�8 j�+�o
Commission#HH 0176 6Mir ZZQZ'Qr: "f%Y;
,OF F�•�° Comm,Expires
J
REVIEWS FRONT ZONING SUPERVISOR PLA a •� og
F t MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ---
RECEIVED
DATE
COMPLETED
ev.5/6/20