HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE. COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. �• � Permit Number.42--�03 r
RECEIVED
MAR - 4 2022
Planning and Development Building Permit Application Services St, Lurie County
Permitiin9
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: ��7 ��� dL� 012 T R)rr'l 0cr �•L�l �.
5 ,n ) / r-, % / _ /-1 r N /= i`� - Hl Ir1 i_ '7 . -.-
Site
Plan Name: Block No.
Project Name: ,��}�� Ji�%8"V�� 642x
(A P P)17r'&+riP _ 1-ynr, 4--r> >o — 4-c
New electrical Meter Second Electrical Meter
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: D21 0 Sq. Ft. of First Floor:
Cost of Construction: $ 0 8 Utilities: _Sewer _Septic
Building Height:
a
3=
d r
rt1`fRAGQR•
Name
Name: Q W d?
Address. D T 6-
_Company:
City: State: r)--
Zip Code:3 V S) Fax:
Phone No.
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail: iQ
Fill in fee . ple Title Holder on t page ( if different
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 $7,500 or more, a RECORDED Notice of Commencement is required.
-W `:;"i'} vT _5{..# ` ...,.:• ��,,s, w p�:` '" -°3A��£$`." '� -•
lVt r.j1y
�d'
Y3?�i�.'-
5:.u`: 2 "k,.�-M`i�+gj
'�4g-
vi'y -��M
±?^.r:.A�.'^r:Y...,."t"6i bL�v.��. .i+rr.
w'�",'�,rQ. T:l:�?:-yu�I. -whi1''i;. tX`.','.Y?�-` �e�.'.? -.r 4'.�.�`P...��SYma"Y�.�Tr►E�s's .f°�,Cvs<tt.�'
�'fiDipR�a 4�•'..'%'s3i. �.'z.''F"4"....
DESIGNER/ENGINEER: .—Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Add ress:
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 aii respects, perrorm 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 attornev before commencing work or recording our Notice of Commencement.
tgna a of Own / essee/Contractor as Agent for Owner
Signature of Contractor/License Holder .
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 1 (! 1 e.
COUNTY OF
Sworrto (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Y Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 20g;2by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Knowny OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
f ^•erg
(Signature of Notary Public -State. of Florida )_
(Signature ota ,:,Rubli:G—St-ate�of.Flarida. �
AUDREY B. HUMPHREY
2o�PPVPUB4c;
Commission No. ':: MyCCMMI(S',n9)#GG300817
Commission No. (Seal)
=� • ` ' EXPIRES: March B, 2023
Bondcd Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS'
VEGETATION.
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU