HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMOr t. 'D FOR APPLICATION_ TO_ BE ACCEPTED 1 ' -1
[gate: Permit Number:) �% T
RECEIVED
Building Permit Application Nov 19 2021
Planning and Development Services
St, Lu o ty
Building and Code Regulation Division Commercial Residential , Pe ng
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
;PRP O5EDJMPROVEMENT LOCATCON.
Address:
Property flax ID #:
Site Plan Name:
Project Name: _
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DETAILED DESCRIPTION OF WORK
N?w EleCtrKal Meter Second Electril gl Meter (Affldvit reuired)
CONST VCTION:INFORMATION
Lot No.
Block No.
`Additional work to be performed under this permit— check all that apply:
,,�M�ecanical _Gas ank _Gas Piping _Shutters _Windows/Doors _Pond
_ €lectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Kor ( '��i Utilities: —Sewer —Septic
Building Height:
;OWNER/LESSEE':' = ..
CONTRACTOR:
Name 4 "'
Name: b \
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Address:D b C
Company: � _� h\_ i'ha
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City: State: Y—
Address:
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Zip Code: L( Fax:
City: P`
Stater
Phone No.
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Zip Code:
Fax:
E-Mail:
Phone No h-ice
Fill in fee simple Title Holder on next page (if different
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from the Owner listed above)
State or County License
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It 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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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:,
Name;
_
Address: Zvi
Address:
City: C'h St e•
City:
State:
Zip: e �C� Phorfe ZOO- Lf
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Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name;
Ngine:
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 fQ11owing building permit applications ere exompt from undergoing g full canctirrency review; rQQm additiAns,
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 vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF F'A e j�
COUNTY OF � [w
Swor to (or affirmed) and subscribed before me of ysical Presence or Online Notarization
this day of ' X. tv, -, i 20-aCby
Name of person making statement.
Personally Known _)!�OR Produced Identification
�VDe of Identification Produced
(Signature of NotaryPublic- State of Florida)
F,NotarY PubfiC state of Florida
Commission No. (Seal) Danyel JonesMyCommission GG 352016
Exp"es 071041202w����
REVIEWS FRONT ZONING SUPERVISOR PLAINS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED