HomeMy WebLinkAboutBuilding Permit ApplicationA-'! irPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date* Permit Number:
�a lsl� I�lllS ..
RECEIVED
Pullding Permit Application NOV 19 2021
Planning and Development Services St. L cie C96n3y
Building and Code Regulation Division Commercial Residential Pe
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: &CD
Property flax ID #:
Site Plan Name:
Project Name:
Ne►M Ele�.tri�al Meted Second Electrical Meter (Officlayit required)
CONSTRUCTION INFORI1fIATION ' t
Additional work to be performed under this permit —check all that apply:
_Mechanical — C�as Tank —Gas Piping _ Shutters
Electric _/Plumbing _ Sprinklers
Total Sq. Ft of Construction: a
_ Generator
Lot No.
Black No.
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Cost of Construction: $ QUtilities: —Sewer —Septic Building Height:
OWN ER/LESS E'E
_F ., w ,. ,......
CONTRACTOR
Name
Name: 1r, 14
C ca &
AddressCXD
Company:
C%I
City: �S ( State: _
Address: -
V
Zip Code: 3gC1 S Fax:
City:
b State:,,
Phone No.
Zip Code:
Fax:
E-Mail:
Phone No 7 1 `"
/ q -0-P7
Fill in fee simple Title Holder on next page ( if different
E-Mail
PWJI 7qe(9Ar14J
from the Owner listed above)
State or County License
00 ¢ f
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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DESIGW NGINEER•
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:-
-; -Address: V F
If,
Address:
City: Jfp ro OM r, '1 (
State:
City: State:
Zip:�Phone[,o.c,_
L(S9V
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: _Not Applicable
N-net
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 certifv 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 all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fQllQwing Euilding permit eppliCetipms_ are exempt. from undergoing a full PQm:urrency review: rpom edditipms,
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 apnattorney before commencing work or recording your Notice of Commencement.
of Owner/,Lessee/Contractor as Agent for Owner
STAB OF F A� (( A C Ai -AL
COUNTY OFF
Sw o (or affirmec) a d subscribed be re me of Physical Presence or Online Notarization
this day of r 20�Xby
Name of person making statement.
I onally Known OR Pro entificatLo
"7�iAe s# Identification Produced 7
(Sigkature of Notary Public- Sf* of Florida )
Commission No. (Seal) �.rR*P Notary Public State of Florida
J. Danyei Jones
y :, a My Commission GG 352016
�' ci � Expiires 07/04/2023
:4 ��Y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATVRTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED