HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: I �.�_ _ Permit Number: ___
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° �'- Building Permit Application JAN 2021
St.Lucie County
Planning and Development Services . Per,. fitting
Building and Code Regulation Division COmlllePClal x Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION `y k 'r'' "
Address: j �u ►� —ol
Property Tax ID#: � J `GT C� �j ��V�/ _( J� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED=DESCRfPT10N:OF 1NORK
Cyr T
-f- Se e 17 Cd
c0 'Ur `S �-G
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION I:N.FORMATION
Additional work to be performed under this permit—check all that apply:
_Mechanical —Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing [ l _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:-_f Ton Sq. Ft.of First Floor:
Cost of Construction:$ _�00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR-,
Name u i e e ;L Name: Zx2
Address: Company: S J/
City: F-Sr'�` P/ff(� State: L Address: 1!3 2vnun(/O S�
Zip Code: Fax: City: �or�— i elCe State:
Phone No. qtpo—_3[�p — o-76 0 '- E- Zip Code: 3�-q Fax:
Mail: Phone No 77.)_ !3 31 _5192
Fill in fee simple Title Holder on next page(if different E-Mail d�t� �l1 rem
from the Owner listed above) State or County License t
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.
SUPPLEMENTAL CONSTRUCTION-L(EN-LAW]NFORMATION
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 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.
Signature of Con actor- -Owner der as applicable
STATE OF FLORIDA
COUNTY OF
Swopo(or afFr ed)and subscribed before-me of Physical Presence or Online Notarization
this � day of 20 a_�*
Name of person malking statement.
Personally Known OR Pro ed I ntification
Type of Ide tificationEduced
(Signature of Notary Public-State of Florida)
�otPaYo�e,,� 1</-1REN S. NiELSEN
;_ .State of Ficrida-Notary Public
Commission No. (Seal) *= Commission # GG 2074E4
rn Ccrrimission Expires
I
J_ine 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rey 10112721
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