HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J�J
Date: �I�Y I z?. Permit Number: ""
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_..9.- ^ �, . ^ Building Permit Application JAN 2 = 2021 .
Planning and Development Services Sr.Lucie Count
Building and Code Regulation Division Commercial Residential Pe Cling Y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1.553 Fax: (772)462-1578
PERMIT APPLICATION"FOR: h)15p, fdaI U>ER 'PF/Z>V rT'
Address: S�Og kr"LfiCiK�$� 14�E
Property Tax 1D#: 13oi - /3 o376...0bp/j�/FS,ce-6w eL-o o` fu-s4) Lot No. /a
Site Plan Name:�( }"IbT!EC" tr9w(p 5�j' pg/.!4 . (AS SNo l c,a Block No./53
Project Name:i ftWeL en0b PAQI( P 044
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Amca-cho o 11 SL CO (L D GAK14 Er .�'� 3 X d) ?MC o'
New Electrical Meter Second Electrical Meter (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: 46 Sq. Ft. of First Floor:
Cost of Construction: $ ,# J,200 Ob Utilities: —Sewer _Septic Building Height:
4\ - �4 -��`� - _ ?� �.p01
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Name WdluW P, ) er �s r �w_+¢ Name: -104 A0-mtl g
Address:
__S__GO Kt IlaQ1J "Aue Cornpany:Ae iw?
City: Fb&T PteP-4e ..State: r-4 ' Address:
Zip Code:_JY9S7-/'1821 Fax: City: State:
Phone No. ?72-AKA e gg Zip Code: Fax:
E-Mail:_WF2DaTAbA52Q/o ocn-LMK.CdW Phone No-y�f'3-3o
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: 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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants.that may restrict'or prohibit such
structure. Please consult with your Home Owners 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 ail respects,perforrri'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_jo_bsite before the first inspection. If you intend to obtain,financing, consult
with lender or an attorneybefore commencin work`o� k �recbrdin our Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed) ands bscribed before me of Physical Presence or Online Notarization
this day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification ✓
Type of Identification Produced �I
(Signature of Notary Public-S ate of Florida)
Commission No. ' (Seal)
. . , Yp' HEATHER BURFORD
2�ZP UB i� .. ._
;State of Florida-Notary Public
Commission # GG 183217
F bruary 06 20 2�r J
REVIEWS FRONT ZONING SUPERVI O T _RTLE,_ MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW kEVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 Z 2