HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMir r_ 'ED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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91M. n LIT QU� ELT RECEIVED
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�Yvl* JAN 0 3'2022
101'�Planning and Development Services RTE ET'ti4T L St.Lucie County
SA S T�,-��IIpp��`y1L Perm'ling
Building and Code Regulation Division TL Qi RIE�rClal Residential
2300 Virginia Avenue,Fort Pierce FL 34982 C,
Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding e;®P
PERMIT APPLICATION FOR:
PRC�POSEDIV)PROVEISt1ENT LOCpTiCN
Address: �9� .�,a��..Ae�o v�i'S.�1
Property Tax ID#: �T� �' 7• �y b ��• Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF lEVORK
i 7 S
4"iTB,01,�-,e/ 4ej� !/.-p?' e /X/z/S
New Electrical Meter Second Electrical Meter (Affidavit required)
CNSTRUCTtON iIVFORMAT(ON A,
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Y Electric XPlumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
Name Name:
Address:•5,9®O ;�rA04i0 G40• Company:
City: ?:�T- Plelze- ' State:Ff Address:
Zip Code: Fax: City: State:
Phone No. E- Zip Code: Fax:
Mail: C�,r/i.� �✓ /lsp� , ,�/G�' Phone No
Fill in fee simple Title Holder on next page(if different 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.
DESIGNER/ENGINEER: \,a Not Applicable
MORTGAGE COMPANY: ___,>?4ot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ,Not Applicable BONDING COMPANY: .,i!5Not 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 Countymakes no representation that's granting permit will authorize the permit holder to build the subject structure
Association
which conflicts an I ion rules,bylaws or and covenants that may restrict or prohibit such
applicable Homeowners
structure.Please consu t 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 your Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORID
��- - Luc 'I r
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this z3L—day of Q A,, 20,2Uby
'Cr,
Le vyi(a rdl rntt1-iidy_111P 0
Name of person making statement.
Personally Known OR Prod"Ceentification
Type of Identification Produced
L�y
(Signature of No y Public-State of FloriA) V
A,IDREY B.HuiviPHREY
Commission No. (Seal) p% Nl,e CoMt,11SSIoN it GG 300817
r,PIRF-S:March 6,2023
Bondled''i hru tjotaq Public Und
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 0/12/21