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HomeMy WebLinkAboutBuilding Permit Application 1 � All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Numbedccj © � pl(f�1- -IV RECEIVED iai,.Wn-­- Building Permit Application Planning and Development Services I EB 0 9 2021 Building and Code Regulation Division Commercial Resideritia4unty q 2300 Virginia Avenue,Fort Pierce FL 34982 Permitting Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding PERMIT APPLICATION FOR: d✓I C�C �1�.�"iC��/1 PROPOSED IMPROVEMENT LOCATION: Address: ' �(O I 1 ;,C - or^V f f orb �'�Br=e ¢- �. . '3 Property Tax ID#: gocZ - a — 61 CC 0 00 '.3 Lot No. Site Plan Name: Block No. Project Name: e. DETAILED DESCRIPTION OF WORK: New Electrical Meter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: Additional work to be performed, under this..permit—check all that apply: _Mechanical _Gas Tank as P' ing, _Shutters _Windows/Doors _Pond Electric _Plumbing rink aerrrss✓� _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Vn6�(- 10010 Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR- Name (`� l Name: Address: ": -q 6 4 �� � w��lc� � 1' • Company: City: �cyr'�- R �G� State: , Address: Zip Code: Fax: City: State: Phone No. !7e702 '�00— �';�002 E- Zip Code: Fax: Mail:f' YY3c �i�+'.-# L� ate}- • ne,+- Phone No Fill in fee simple Title Holder on next page(if different E-Mail 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. W DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: � Name: Address: Address: City: G State'. _ City: State: Zip Phone 77-7 7F; C3 ilZ 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 iri paying twice for improvements to your property. A Notre of Commencement must be recorded in the public records of St. Lucie County and poste�d on the jobs•iVbefore the first inspection. If you intend to obtain financing, consult with lender or,,m att rn beforp�� mmencing work or recording our Notice of Commencement. Sig ture ofpi . r essee ontractor as Agent for Owner .STATE OF FLORIDA COUNTY OF Sworn to(or affirmed and subscribed before me of �' Physical Presence or Online Notarization this A,day of f2q)4�by Name of person making statement. Personally Known OR Produced Identification Type of Id ntification Produced (Signatde 4 Notary Public-State of.POrida) ! �rnrop'• LA$ MY ►JAINGItgM. MIND Commission No. (Seal) $ =� A1ISSION#GG275460 ' +•or F,,�.• eeIEXPIRES:Decs er20,2022 ... Notary brit U� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2 21 .