HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (t')
Dater l ' 'I Permit Number:_Q V 6 z CU
LUC RE RECEIVED
n -- Building Permit Application AN 21 2022
Planning and Development Services St.Lucie Cou
Pe,rn tti
Building and Code Regulation Division Commercial Residential
r
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
'a. uaf" '7` 'xs`�,�yq(7s r �, .zc �, v x
x
Address: -1
Property Tax ID#: �OO Lot No.
Site Plan Name: Block No.
Project Name: ,\Ck6L_ l�o OtU
'Dl��r���IJ-t}���1�1P�{�l�z�is�� � .�i�7'• "�.x-'� �,� �,y `^^ .�i��pi sl n �3C��' »F L'�#;' ��.Ytii ����.aus�4�t�.�, a � �
�� �,,...3;�_,z ,y.�,,r� r -''-- pie -�.;,�,h.s n '.�: ,sr�"'��, ;x•f�r r.:.: �r >.�e..,�. -�,.�.'�-"��"' �" �.,.r,C � _r�.:,...�r �r"'' E';,`�.r. r1r,}-�,���� .F
�`= t��LAC dL 4 C._ t(c l c�-t 1f 1—'� H V��"[J'L�f C.r_ � �► 1^��Vim_�,..A��l ���d�L�
, i r
New Electrical Meter Second Electrical Meter (Affidavit required)' I
•s'+4.--� - .. .3 .Y.. a ��_b .. i l���S ,l �. � A'�� � � i x ,..'`-R"i'"��€V'�� •�'t� 1 x���' _,,.'y��'E..���rx."�,k'=a-`�
Additional work to be performed under this permit-check all that apply:
Mechanical s Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ L.__'AE;O . C�kn Utilities: _Sewer _Septic Building Height:
4,J'� � �L��J�F e '� '�r•� e €��r„ aai �? e��!� � # i t� } �§' ��k�"� �i� 5a�� �c-�-"
a...Name f'4Jl_ MaS'T-t ate' Name:
Address: Company:
City: �o��-t ,Pt Cl_C_ State: �` Addr s:
Zip Code: a Lo t City: "e-A — State: t�
Phone Not1 ti 4�Lo4it E- Zip Code: 3 1,4'L0,� Fax: c) of
Mail: U1O `LJ'L Phone No (Z-I-k l to
Fill in fee simple Title Holder on next page (if different E-Mail WwAn k MOWN
from the Owner listed above) State or County License L.I=t--n l.a-N 2:�'
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,-�r.�.i'�"��v`T�e"�� `ie'e��".r. �-ny'r�-ss�'c��� 4"� -3f5�+i?c-T�t �...:>?'PwYe ^"n"'..'�s�. '.,,'.'�F.'?� �u.. x;r- 't# <'�,'S'- r�" �..
�•�,:;,.. "� k.:�.4Sz'�:.�'. s..Y»s+,.���•c...s:Yi.'.a'.`M�k.t.� ' tea,.... "'i`�"s- �'6.?�.I.io;.- a�'4�.�..�.�".�.�n.'a:Y" .roilP� ?F.r.?s�. ei.^�.`u.d-•�.."�:•!;',- .�� . e_"�S�nr��x��.i..:
DESIGNER/ENtiGINEER: _ Not Applicable MORTGAGE COMPANY: Not 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.
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 conflicts with any applicable Homeowners Association rules, bylaws or anal 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.concur•rency 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,befoee the first.inspection; if you intend to obtain financing, consult
with le er or' attorne before commencin `work or recordiri our`Notice'of.Conimerrcement:
Signa f C ntract or-'Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affir ed) and subscribed before me of Zysical Presence or Online Notarization
this day of 11 22R by
�
� 11 I t11} r��I -
Name of person making statement. /
Personally Known OR P Vd Identification
Id
Type o entification Produced
(Signature of ota Pu lic-State,of Flori(aA)
Commission No. "�' (Seal) ' osp�Nr 4UDREY6.HUMPHREy : - -
_. _• — _ MY COMMISSION 9 GG 300817
UNEXPIRES:March 6,2023
-' '•;9'F ;° ,B,,MW Th.Notary Public Underwriters ,
REVIEWS • FRONT ZONING- SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW- REVIEW REVIEW REVIEW REVIEW - REVIEW
DATE.
RECEIVED. .
DATE-
COMPLETED
Rev 10/12/21