HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII �+►F LICABLE INFO MUST BE COMP, -_.. =D FOR APPLICATION TO BE ACCEPTED
Date:�� Permit Number;
RECEIVED
oE 'R DEC 2 3 2021
St. Lucie County
Building Permit Application Permitting
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
....e - :r :..a _ s,, i. r r�.. 5 x rr' c z N,,, - ..: ir` ; z,.: :
an��e7ggkgo
a x r r r a .,x ..a-..E �--rs s€Y�'st ji� .ti -v xr za i.'ak'mTr-ems
Address:3a60 SU) S� "�UV�'�I erCQ IiZ7�' 3Z{
"Property Tax ID Lot No.Ck 4
Site Plan Name: Block No.
Project Name:
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: ,-rl Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
t^_F[r� h Y �' t,i` 3 ^C, l�y�1 'G b
C 27 4,148•AS*S6i'''fi
t :, _� $�y�►jt R rF �Y33�` Y �' '5.. tl6",'��{5 ,.:#
Name
Gt
Name:
Address: ✓ ice
Company:
City. aM-ICd.A State: _I .
Zip Code: 3-:�C`(nL4 Fax:
Phone No. CI— IqAL4 S- E-
Address:
City:
Zip Code:
Phone No
State:
Fax:
M a i lDaatJcL a (o , CaIrl
Fill in fee simple Title Holder on next page f different
from the Owner listed above)
E-Mail
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.
ME
011 WIWI
yeyv
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 an� applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
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 attornev before commencina work or recording our Notice of Commencement.
7
Sign re of Contrac or - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF ;fit+'• "c.vf�_
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 'X:S day of 20a1 by
\
d
Name of person making s atement.
Personally Known OR Produced Identification
Type of Identification Produced �:L f\L
(Signature of Notar ublic- State of Flor'
Q
DEANNASIa e p,orida
Commission No.)1A Ja paajPob� ion HHOS6152Dti5
Comm Exoresa Notary Assn•
�; My tram hNation
�''�',oc
�"8onded tfirou3
e
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev10/12/21