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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ^`� L. JAN � 4 -- °"�:'. Building Permit Application u021 St. Lucie County ty Planning and Development Services Permitting Commercial `Residential Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 e�D��-,� PERMIT APPLICATION FOR:gil Address: 9 ® ni n2eU2 �rcl� �' �°e YProperty Tax ID#: "� =4V/ No. 4 t2Site /�Lot Plan Name: C\ .r? :5 U)a. fC Fa Y% Block No. kpm Project Name: � Y% £' �© t2f P) (�/� 1'( lh �,�%� e5W 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 —Shutters Windows/Doors _Pond Electric — Plumbing — Sprinklers — Generator — Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: ,J Cost of Construction: $ �� L Utilities: Sewer _Septic', Building Height: WName Name: t V—DYl 0 ti %1e' . e S 0 Address: f� j U)• Company: Cit I /er 40 S ate: Address. / City: Y� Zip Code: Fax:' Phone N J� Zip Code: Fa Phone N E-Mail: f Fill in fee simple Title Holder on next page ( if different E-Mail tl 02 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. A/js ewtrfe/d- MOM 0 AGE COMPANY: Not Applicable 7Address: DESIGNER/.ENGINEER:" Not Applicable Name: ' ' 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 ofa 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 Owner/ Lessee/Contractor ent for Owner STATE OF FLORIDA COUNTY OF d J C �. Sworn to (or affir ed) and subscribed before me of Physical Presence or Online Notarization `Ci.by thisday Z B Name 4erson making statement. Personally Known "' OR Produced Identification Type o dentification Produced J (Signature of NotaW Public- State of Florida) _'""j " 1111111�,••�aY B. HUMPHREY P� AUDREY Commission No. (Seal) MYCOMMISSION #GG300817 EXPIRES: March 6, 2023 { dTPublic undervirilers r;j'lFOFF;°P BundehruNotary REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW .REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2 21