HomeMy WebLinkAboutBUILDING PERMIT APPLICATION i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: NtutIVED
JAN 0 7., 2
o r
5t.Lucie County
Building Permit Application Permitting
Planning and Development Services
Building and Code Regulation Division Commercial Residential y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
-
Y 1{iiirT✓ # � al{ Y-:i ''.S•-rF rf'hP SS
Address: G o7 5/O I-y et n��_ F-o4 Pf e-ree F&jeI' �Z(J82
Property Tax ID#: ?D�0- -G IO - OU--(000-0 Lot No.
Site Plan Name: Block No.
Project Name:
-RAYS3 .F s �`� �y" fAs `i p�.:a v' ^a -^�
'x $r2 K -.rz x`"
Sto
New Electrical Meter Second Electrical Meter (Affidavit required)
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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 __v Pitch
Total Sq. Ft of Construction: OO Sq. Ft. of First Flooir:
Cost of Construction: $ a�a.d a Utilities: _Sewer _Septic BuIilding Height:
RM
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Name U D" Ird✓ Name: e(,�-PiUI rVl ILl �« i''i7V
Address: CO O`j S iTtA C( Company:,;;
City: ror P(cV 'Ct State: FL- Address: G (-0 G r-
Zip Code: Fax: City: rov+ P l P iu State: Pl.-
Phone No. 772 32-L 0200 E- Zip Code: '64992— Fax:
Mail: UacA-roy 0 _ t(S-A c Cd'W\ Phone No <772 32LI C100
Fill in fee simple Title Holder on next page (if different E-Mail Vt• cz►t4 _
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 requireid.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: of 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.
1 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.
JdY""v
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sk. 1.vC��
Sworn to(or affir ed)and subscribed before me of _Physical Presence or Online Notarization
thisl day o '"n 20a�'by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced d 1n't 6.<%4b Z 44&
(Signature of Notar ublic-State of FI ri
DEANNA GIVENS
Y°° '=- Public State of Fiorida
Commission No.sx"O'kows ' �_; Notary
o Commission#HH 086 .2
o?:` M Comm.Expires Jan 28.2025
` �� ; y y Assn.
Bonded through National�otary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 20 2