HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
]AN 2 5 2022
Building Permit Application permitting epaltment
Planning and Development Services St i.i,r;A r'ou
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: CSCc'� Gn ,/ Aaca r+-
Property Tax ID #: p�3c�3—o�� �- S-1 0U0 Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: f
Cost of Construction: $ �� y� Utilities
Name ,/C410-T �ZT-'.4 d ���5
Address: 2_4 9'0 L; /0y GQ�a
i
City: �%�� �izG ;t State -
Zip Code: 2'Y�7z%s Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Shutters
(Affidavit required)
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Sewer _ Septic Building Height:
Name: 1_10,il cf
Company:�� N� ��1
Address:_; 2/S_6&J '6&M 6q
City: Stater
Zip Code: c��g_�c3 Fax:
Phone No <,,�
State or Cow License / 6 LY 761
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.
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 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 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.
I
Signature of Owner/ Lessee/ ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF s J .r ' !--
Sworn t (or affirmed) and subscribed before me of _ P`� hysical Presence or Online Notarization
this day of
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced DZ/
9 0-ac�& ,
(Signature of Notary Pub li State of Florida )
Commission No. (Seal) - HEATHER BURFORD
= �- State of Florida -Notary Public
GG t8
l a Commission # 32t�
oa,•` My Commission Expires
" Febr _
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21