HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF MUST BE COMIR _,-i;'D FOR APPLICATION TO BE ACCEPTED
Date: D Permit Number: V ° O ��/
RECEIVED
girl dC� IE OCT 2 5 2021
0
Q Building O gM��Pplic�
M
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
AUDREYB.HUMPHREY
MY COMMISSION ft GG 300817
March 6, 2023
��`&°EXPIRES:�'' f ..,t.,d'iLa! t•1 'Fry I�c::io Undenti!!ers
PROPOSED IMPROVEMENT LOCATION:
i — . w I -NI _ I - — _i _ A % - a —a of A n es p.
Address: 4 V
Property Tax ID #:
Site Plan Name:
Project Name: _
�J �) I c�- ' ®oo e)- — o0® Lot No. —I
Block No. t
DETAILED DESCRIPTION OF WORK:
'i�'Vk'CA016 IN
GCv4-e1r1 irV`
'!kkti oor'
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
oe s W eil e
(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: gaol
Cost of Construction: $ 3 Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: -
CONTRACTOR:
,
Name . Y--ew
Name:
cc4�� Q�F?C>;
Address: ((FJ Aai A fit°
Company:
City: fi4.yk-f ` '-� State: _
Address:
Zip Code: Fax:
City: State:
Phone No. E-
Zip Code: Fax:
Phone No
Mail: uiv 1
ll
Fill in fee simple Title Holder on next page (if differen
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.
t »
i
ffAddress:
ENTAL CON
ENGINEER:
--
Phone
LION LIEN LAVI
_ Not Applicable
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone•
INFORMATION:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone: `'`
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.
I certify that no work or installation has commenced prior to the issuance of a permit.
w Lucie County makes no representation that is ranting 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 re uest d
4 e permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the a,
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.Your Notice of Commencement.
of Owner/
as Agent for Owner
STATE OF FLORID
COUNTY OF
Sworn to or afFir ed) and subscribed before me of
this day of 20D1 by Physical Presence or Online Notarization
of person making statement.
Personally Known OR
Type ofildentification Produrp,
(Signature of Notary blic- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
tl
=o.• "tH; AUDREYB. HUMPHREY
MY COMMISSION # GG 300817
EXPIRES: March
v_
8
8onded Thru Notary Public Underwriters
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW I REVIEW