HomeMy WebLinkAboutBUILDING PERMIT APPROVALAll APPLICABLE INFO M SJ BE MPLETED FOR APPLICATION TO BE ACCEPTED .
Date: Permit Number:
St. Lucia County
Permitting
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Building Permit Application
Planning and Development Services
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:
IN - ... _
Address: �b� C'C►==C��C,0� 2�G 'L,�l;���
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Property Tax ID #: `1�� \ " 0 3 i >� O Lot No. —1 +
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Block No.
Site Plan Name: _
Project Name:
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- cC&_ oiC
New Electrical Meter Second Electrical Meter (Affidavit required)
51
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N-M
.gym
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:
Cost of Construction: $ 71,3 6 a Utilities: —Sewer —Septic Building Height:
wName
��u►G�� eW0-C Name:
Address: Qb� I�C GAG f� <� Company:
City: %OC�IerCe State:E_ Address:
Zip Code: q%c3ti Fax: City: State:
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Phone No. $ 5C0- �� 1 3 �� Zip Code: Fax:
E-Mail: ��C�n �C �� Q S�eci�'� QDk-CO Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
t is re uirad
If value of construction is 2500 or more, a RECORDED Notice of Commencemen q
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
ODDEWSIGNER/ENINEER:
Not Applicable
MORTGAGE COMPANY: o't Applicable
Name: Ide
Name:
Address: id -al SO AVC
Address:
CState: IF=
Zip: --j L 1a t,. (P Phone'J50-11"I —k; 35
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Applicable
BONDING COMPANY: ot.Applicable
tlzaot
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 uvork'or recording our Notice of Commencement.' '
Signature wner/ Lessee/Cont or as Agent for Owner
STATE OF FLORIDA` see
COUNTY OF l..) CA
/
Swor to (or affirmed) and subscribed before me of � Physical Pres Notarization
this day of ,j 2022by
Name of person making statement. /
Perso own OR Pr.duced Identification V
Ty of I ntificati n oduced �L
(Sig atu of NotaryP blic- State 6 Florida) JCS®Tl HePldrY
Co mis ion Nc"1 U�Aj (Seal) =�' e COJntniSSi1�
= = Expires: Fekiary 23, 2023
Bonded Thru Aaron Pfotary
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Rev 21
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 o ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed befo a me of _Physical Presence or Online Notarization
this —S day of V�' 1 , 20��
Name of person making statement.
Personally Known OR Prod d I ntification
Type of Identification Produce
CQ
(Signature of Notary Public- State of Florida )
Commission No. LEN VAUGHN
?=�`PpYPGA�;State of Florida -Notary Public
=* *_ Commission # GG 270079
;9rEOFF`oP�; My Commission Expires
nma
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE'
COMPLETED
Rev 2