HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
RECEIVED 2
Date: Permit Number: 2 � 1
FE3 ®2 202'
St.Lucie C ty
i✓ I i.� 5 Permitting n
Lr Building Permit .Application
Planning and Development Services
Building and Code Regulation Division Commercial Resid-ential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: FO G--V� rl') On y CCirl G N, Lo(Z(� Q T� 3 4 9 K7
Property Tax ID 4: (Qn ( Lot No.
Site Plan Name: Block No.
Project Name:
1 �_ �S�F� �����s �"�"�.a--- .?..r -�•r �.r��� �" "��sk�. �� �..5 x�v. Fn�"�..av ��r � � �.�e ,z` t :,
New Electrical (Meter Second Electrical Meter (Affidavit required)
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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: $ �2 , LLo o D a Utilities: —Sewer _Septic Building Height:
Name CA ve Name: C7S�
Address: j ma y- S � 12—``� _�i�►L �'2 Company: M'21*1 XA/G
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6�1 L 1�1t7Wlc� Wl/11/[�2S
City: 0 1�l` (� State:/�Z Address:�5�j�`{- j1fj'jV C C('24 1 c)
Zip Code: 3 _ Fax: City: �1[ &}� �jQeAc h State: ,
Phone No. 5 L - ' f `7 E- Zip Code: �,;� 77 Fax:
Mail: Phone No 5:(a /^ r/S - S � /0
Fill in fee simple Title Holder on next page {if different E-Mail m�-i chef S�Q�/�S, �/ 1�1(2 •CON-I
from the Owner listed above) State or County License
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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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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:. City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE FOLDER: 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 your Notice of Commencement.
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Signature of Cantractor-or-Owner Build r as applicable
STATE OF FLORID
COUNTY OF
Sworn (or affirmed a d subscribed beforeme of Physical Presence or Online Notarization
this Sworn
of 20a .
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Name of person making statement.
Personally Known R Prod d Ide tiff ation v
Type of Identification Produced ��
(Signature of NotN4 Public-State of Florida) ,,PaYP�a%'
;ate ;State of Florida-Notary Public
*_ Commission # GG 270079
Commission N�d0?(sue (Seal) My Commission Expires
October 22_, 2022
REVIEWS FRONT ZONING SUPERVISOR. PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW I REVIEW REVIEW
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