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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / r Date: 7 49 7-7-- Permit Number: vv S La GMI E_ RECEIVED Building Permit Application 0 ZQ 21 Planning and Development Services St.Permitti un 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: 4" &4 PROPOSED°IMPROVEMENT=LOCATISQN Address: . gS"�� Property Tax ID#: Lot' q o. Site Plan Name: Blo ck No. Project Name: DETAILED DESCRIPTION OF WORK ' ����s�n�CJy� .,Z's/-��,�-I.-_ l.��l:g i� ��S j�-'�� ��,c� l✓Lr�/�i[� ���s ��R>>� _ ©� New Electrical Meter Second Electrical Meter (Affidavit required) C(7NSTRUCTIQN INFQRIIATION Additional work to be performed under this permit-check all that apply: ZMechanical _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: $ ;;-Q Utilities: _Sewer _Septic Building Height$ QINNER/LESSEE CONTRACTOR a. Name Name: .L7�� � Ae �sGLf S , Address: :% Company:�1�,� ,r2�/��y���,� -r'>J al City: tate� Address: -- Zip Code: 35�!9af 7i Fax: City:Pf State: Phone No. g" �y - 7-7',z) Zip Code: Fax: E-Mail:, Phone No 7'R a-2p" - ,i',_4 Y_'-'6 Fill in fee simple Title Holder on next page( if different E-Mail iLLt4 (J 5� rt-- l: ,,11 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. SUPPLEMENTAL CC3NSTRUCTIQN LIEN LAW INFC}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 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 our Notice of Commencement. Signature of Owner/Lessee/Contractor as g nt-for Owner STATE OF FLORIDA COUNTY OFLo Sworn to(or affir n subscribed befp{ e of Physical Presence or Online Notarization this day of 20L c cl& I Name of person making statement. / ✓ RYPL KAREN S. NIELSEN Personally Known OR Produced Identification =s°�P e`� State of Florida-Notary Public _> *= Commission # GG 207484 Type of Identif' ation Pro q�ced \ \ -� 1 9rf `oP My Commission Expires ,, anf1`'p June.12 2022 (Signature of Notary Public-State of Florida) zzT*LSN�18V)l , �pRYPUB/, HEATHER BURFORD Commissi No. ;o se " State of Florida-Notary Public b8bLOz iu.� ion _, • Commission #GG 183217 olignd /'�e { }o ' o'I, My Commission Expires N3S� February 06, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5/20/21