HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application �zoz NVr
Planning and Development Services a3A13038 Y
Building and Code Regulation Division Commercial Residential C`
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PRaPC►S,ExD�IMROUEMENT�L "CATIQI� #r
Address: 113 4L1F�n1 G4�2.lSTttaA cC + d�� �.�1��c�1 %5LAr4D, TI— % S4`11,4ck
Property Tax ID#: VC)o Lot No. -E
Site Plan Name: Block No. �Z.1
Project Name:
WomIILEG DES� RGPTION ®,F 1IVORK:
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2. REPL Ac_E 2. Dbcy2S w mA i M f4�c--r Dco gS IPL2DE�b-1.
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: Sq. Ft. of First Floor:
Cost of Construction: $ (0347. Utilities: —Sewer _Septic Building Height:
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Name Name:
Address:�11B QUGEN CAQ.k-STIA A CT Company:
City: t-tu ►%f S6 .1 (SLAN'D State: L. Address:
Zip Code: 34t,ln Fax: City: State:
Phone No. 2-% "7(00 2P \?- E- Zip Code: Fax:
Mail: JAQ.IC B 41PEN26SE Q UMAIL.C-OM 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.
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SURPLEII/IENTA CONSTRt 1 TI®N LIEN LA^W INF®RMATION:
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 qn attorney before commencing work or recording our Notice of Commencement.
Signature of Contracto or-bwner Builder as applicable
STATE OF FLORIDA
COUNTY OF 5k I—I U.{-,
Sworn to(or affirmed)and subscribed before me of Presence or Online Notarization
this day of Mnblk,) 20 Zaby
Name of person making statement.
Personally Known OR Produced Identification /
Type of Identification Produced bU
1�� iH46&4
(Signature of Notary Public-Sta of Florida)
HEATHEN BURFORD.
Commission No. (Seal) c80`0"�pb��,5tata of Florida-NotarY Public
•= Commission,,# GG 183217
a Ar; My Commission Ex lros
;GRP February 06. 2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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