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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: OIL ELU-19 ' 9 .. NF W_1111:�;t� Planning and Development Services Building and Code Regulation Division Commercial 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Permit Number: 2u I , 0, , Building Permit .Application JAN Z ,1 2'ij11 Residential st. Permitting PPRIV99 Address: Property Tax ID #: J�� `"�-�� _ O©�� `C> 5 Lot No. Site Plan Name: Block No. Project Name: New Electrical Meter Second Electrical Meter (Affidavit required) 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: k ©� Windows/Doors Pond ✓Roof 1 Pitch Sq. Ft. of First Floor Shutters Generator Cost of Construction: $ ��� '— Utilities: —Sewer _Septic Name Address City:,::! --A, State.L Zip Code7. (� -- Fax~ Phone No. E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) ZC© Name: Company: I tl�Cs Building Height: Address:�, State:K_:7S_._ Zip Code: 3"-�qO Fax: Phone No' 7-7-2. E-Mail �_✓Ct.'����E�C�5.11-` State or County License(2C 13�- t95�7 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 TITLEHOLDER: _ 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 sttuctures, 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 o caner/ Lesse Contract r as Agent for Owner STATE OF FLORIDA COUNTY OF `� Presence Online Notarization Sworn to (or affirmedLand subscribed before me of Physical or t4f this day of 20Oty Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public State of ida ) Commission No. (Seal) HEATHERWgURFORD `o�YP�e� Public i :state of Florida -Notary # GG 1832 '. *= Commission a `- My Commission Expires �',�oFF���` Q6 2022 REVIEWS FRONT ZONING SUPERVISOR LANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2. 21