HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE NFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: D
RECEIVED
OCT 2 8 zOzi
iF 9 .. - • -w Dip • .:
Building Permit Application Permitting Department
St. Lucie County
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: IA497�/ �a ,
Address:
Property Tax I D #:
Site Plan Name: _
Project Name: I
Lot No.
Block No.
Fyn- DY �Cf�=�ti
7� PQ
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 —Wind s/Doors _ Pond
_ Electric _ Plumbing Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 12f Sq. Ft. of First Floor:
Cost of Construction: $ 1 Utilities: —Sewer _Septic
Building Height:
Name's
Name:
Address: b 7)
Company:
City: � J`.P/I,G� State-.F
Address: Y
City: State:FL
Zip Code:Fax:
LjQ
Phone No. r(�, �2^^'— Jii�. D Z
Zip Code: Fax:
Phone No
E-Mail: i/D,""dY • Z2l!/� �(` �✓�• C_6.lejj
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the O er listed above)
State or/CUnty License
If value of construction i J2500 or more, a RECORDED Notice or uommencemem: is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
3111
r
MORTGAGE COMPANY: Applicable
DESIGNER/�NGIWER: _ Not Applicable
Name: % a ��v�
_'Not
Name:
Address: &,+, t i
rddress.
City: c bff L-_ State: „
City: State:
Zip: Phone �/TyT�j gn
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: ;_. Address:
City:! City:
Zp I;liA e._:F Zip: Phone:
OWNER/ 60N_. RACTOR 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 le der 94 an attorney before commencing work or recording our Notice of Commencement.
S1#o��
urof Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Pr duced
gnature of-N t ry Public- State of Florida )
AUDREYB.HUMPHREY
Commission No. (Seal) MY COMMISSION#GG300817
Fm
March 6, 2023
EXPIRES:
Bonded Thru Notary Pubiic Undertrriters
••xxa���sam� v..�aa.�.:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA.TURTLE -
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21