HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
911T.F-LLUCE RECEIVER
I O '
BuildingPermit Application 09 Z02
MAR
Planning and Development Services St.Lucie N Co�IV
Building and Code Regulation Division Commercial Residenti�efi�V: 'y
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
enCc
_ NOW
Address: (O� oii
Property Tax ID#: 3419^ 10, 0))0"0 00 S Lot No.
Site Plan Name: Bock No.
Project Name:
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New Electrica eter P7 Second Electrical Meter (Affidavit required)
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97 CA
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping ✓Shutters Windows/Doors `Pond'
_Electric _Plumbin ,Sprinklers Generator _Roof Pitch
,�,Total Sq. Ft of Construction:_ Sq. Ft. of First Floor:
Cost of Construction:$ SD v Utilities: —Sewer _Septic Building Height:
RM
_ _ -
s `� � = s IN 1.
-NamV-0—If 0—�. �OnJTG.Orn�lZ�( Name:
Address:_6019 /34o-fi f A ve7 Company:
City: A,"T- (.de,0 State:J=f. Address:
Zip Code: 8g9S2 Fax: City: State:
Phone No. 7 72, 36f-49a S/ Zip Code: Fax:
E-Mail: IMA40A 89,t6o ig (/AAgo, Co M 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.
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.
Perm r0001
S44ature of Owner/Lessee/Co ctor as Agent for Owner
STATE OF FLORIDACN
COUNTY OF d 4•
Swor (or affir ed) and subscribed be re me of Physical Presence or Online Notarization
this day of �42by
0
Name of person making statemen .
Personally Known 0 Iced Iden •fication
Type of Identification Produced li
(Signature of Notary blic-State o Florida ) I AU i3.HUMPHR ?;j
S�,f�Y FUG''=�o ...: MY COiViM1SS}ON it FG2D 0817
Commission No. (Seal) -,. ,,, °_ �Xo}RES:1Ytarch
7 Bonded'Thru h•
>II ,r•,�; 4��,'
REVIEWS FRONT ZONING SUPERVISOR PLANS. VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21