HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAB�JLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Number:
Date: Permit
_ M01,111 ``- 511
Building Permit Application JA/V 24
20 21
Planning and Development Services gt, 4u -
Commercial Resident `�,,,;� oun
Building and Code Regulation Division rg
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553'Fax: (772) 462-1578
PERMIT APPLICATION FOR:
y
Address: 3�9Li�
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Property Tax ID #: �•=�oG ��- Lot No.
,Site Plan Name: Block No.
Project Name:
e - NitAYl
-e - 4 G 5 I
.
New Electrical Meter Second Electrical Meter (Affidavit required)
IN
Additional work to be performed under this permit -check ali 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: $ l Y�U Utilities: —Sewer —Septic Building Height:
ma's- .S-
M
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Name:
"Name ? 6 fur I U vti
Address � `� � � �a � lk' � : e
Company:
P y: I
City: I e�(Ge state: FL
Address:
Zip Code: 49 -1i Fax:
City: State:
Phone No. _\_\ 2, - S 01- 3 4/���
Zip Code: Fax:
E-Mail: WillfG W15 Cd e 0 h rl Q YV'XQ'` .(Oki
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or;,Qouayri'Cense ..
If value of construction is 2500 or more, a RECORDED Notice of Commence'ment'is required.-,. '
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencementis required:
Ac, ;.
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 re'strict 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 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 le er or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OFTLORIDA
COUNTY OF �`^(
Swor to (or affirmed and subscribed bef re me of hysical Presence or Online Notarization
this day of 2�Zby
Name of person making statement.
/
✓
Personally Known OR Produced Identification
Type of Identification Produced 2
i
(Signature of Notary Public- Sta of Florida )
HEATHECommission No. (Seal) ;;��State of FloridagORFORD
Notary
Com Public
%° My om�on # GG 183217
W'z
',;;,,�` mission
February 06 2022Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 2