HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �n
Date: -eD V. Permit Number: o � `"
�C i,�� w RECEIVED
rr FEB 2 4 ZOR
Building Permit Application
St.Lucie bounty
Planning and Development Services Perr6hino
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:
Address: /SS ,JQ
Property Tax ID#: 3u19 - S?D �'i4—°' Lot No. 5
Site Plan Name: Block No.
Project Name:
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INIMIZE-
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New Electrical Meter- Second Electrical Meter (Affidavit required)
Additional work to be performed under Phis permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _�SSp''rinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:.
11 4- �• /" Sq. Ft. of First Floor:
Cost of Construction:$ �y/,� . Utilities: _Sewer '_Septic'_ Building Height:
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Name 2uv, iM C,t^z Name:
Address: N@. Company:
City: .��� S� ��-�,� State:� Address:
Zip Code: 2W1'3S Fax: City: State:
Phone No._5 SgSa- — D3u3 Zip Code: Fax:
&Mail:`?dvvry1_ oL-$�) , YIaw •wr'ti 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.
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1 11 §=-
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 Cou y a d posted o, the jobsite before the first inspection. if you intend to obtain financing, consult
with,t9rill or aM attor efore commencing work or recording our Notice of Commencement.
Si a of L ss e/Contractor as Agent for Owner
S ATE OF FLORIDA S4.
COUNTY OF
Sworn to(or affirm )an subscribed before me of Physical Presence or Online Notarization
this day of 2by
Name of person making statement.
Personally Known OR ro ced Identification
Type of Identification Produced
Allil
(Signature of Notary blic-State of Florida)
;i :;,Y,:G:,• AUDREY B.HUNIPHREY
Commission No. Seal 1, ")1YCG�1ViSSIQNnCG3008W
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EXPIRES:i,]arch 6,2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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