HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: Z Permit Numbei.I. C %a" 0 4
EJ CCs�>I '..
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce R 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address
Property Tax ID
Site Plan Name:
Project Name: _
Residential24= ..
New Electrical Meter-- Second Electrical Meter (Affidavit required)
Lot No.
Block No.
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: $ Zf d Utilities: Sewer —Septic Building Height:
��y..Name:
ME
��"'l��rla�
Nam S. ( n`.
Address:'75WY COyP6eATE'1 uA!Y:. _ .,..
Company:S0—, 4+ FCblzE-M
City: LOFS P4-c ap, :State.:: FL;°'•;
Zip Code: 3=�Uv7 Fax: —
Phone No. S b _ l-t 7 $ j(A-(o
Address:i��c� 6, �- �Scm&& L- 40 r
"City:�)4cin (T'7 7
Zip Code:'3 Q o Fax:
Phone No .7 % Z
State:�L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 1J0} o:j 6-� G:S).S FCC-D04-
State or County License_( 4 Cl Fn 19 1 �/ Q
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
�t�� 3Y�_vd�.�F�`�y�N3 ��i.�j�• i?¢{�_n.c-��f Y !- ,�,y �i
4 ��'��^�`+'. =3R � �F%�� ��� L�v��''„�+����- � .' ��
Name:
Name:
a••
Address:
City: State:
• •
City: State:
• Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
A • •
• •
•Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain`a-per:mit to do the work and installation as indicated.
I certify that no work or installation has commenced priorto 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 en r an attornev before commencing work or recording your Notice of Commencement.
\,l
Sig ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIQA
COUNTY OF S I .,,�,
Swo n o (or affirmed) an subscribed before me of Physical Presence or Online Notarization
1 ` day of 20k.by
Name of person making statement.
nally Known OR Produced Identification
Df Identification Produced _
(Si nat of —Notary Public- State of Flo%a)
YP LASHANNAINGRAM'R�HMING
Commission No. (Seal) " ` :; �GG275000 ` M1(COMMISSION #
EVIRES: December 20, 2022
.',?ro' F;o;'<, gcndedThNNotarypublicUnderwrtAnr
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21