HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t Z 30 1,-z- I Permit Number:
"to LL:(nu19 gy p}
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential
Address: t 135 QC_Q V I 1—
Property Tax ID #:2>5Xa- OQ '" ��' �' � _ Lot No,
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
Block No.
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors Pond
Electric P-116mbing Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction: $ �5• 00 Utilities: —Sewer —Septic Building Height:
Name\,
Address:
Y
City:'S�trl -PQ�C�'� State -
Zip Code, 5�_l Fax:
Phone No.4'� �- ��Q" S"nn
1. _ E-
Mail: � V VN 0,a`H vL4 - -
Fill in fee simple Title Hol�rer on next page (if di#e_`F�ent
from the Owner listed above)
Name:
Company:C-
Address: kQX\
City:t. g6)Lp k-cc> r State:
Zip Code: Fax:
Phone No-1�,%3"
E-Mail Q_A J
State or County License 0---
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
Name:
Address:
City: State:
Zip- Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip: —
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 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 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 of tractor - or - Owner Builder as applicable
a "'<: •;
!.(�
IfiPrlBEr(LYAIdh I:lt_
3t�7970 i
�
iAY COhhiL915Si0f ## GG
2023
STATE OF FLORIDA
EMarc, 5
XP}RES.-
COUNTY OF \ l
T hru Not �)' 1`2ir urz zrtorc�
Sworn to (or affirmed) and subscribed before me of
✓ Physical Presence or
Online Notarization
this i3 day of'C_'e_C' ,ermV-,P_ ✓ , 2&\ by
Name of person making statement.
Personally Known r/ OR Produced Identification
Type,of Identification Pro uced
e of Notary ic- tate of lorida)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev W/12/21