HomeMy WebLinkAboutBuilding Permit App - Yellowstone CirAll APPLICOLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
,�
V 5, � c' rk -_`- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: &/� � _ 7Z�
Property Tax ID #: �S ` (o �� / Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
G .C/Z a G✓ L CU
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _'Nindows/Doors _ Pond
_ Electric _ Plumbing(,�j _ Sprinklers _ Generator ._ Roof _ Pitch
Total Sq. Ft of Construction: _74'S (/ Sq. Ft. of First Floor: —
Cost of Construction: $ 7 7a ) (U Utilities: _ Sewer _ Septic
Building; Height:
OWNERAESSEE:
CONTRACTOR:
Name �� /'/
Name: .f e
Addr ss( i � CU -(` /Zsi-
Co y if Uf'Z�/2'7�[ _ C
City: State ./5�__
Addres 2 Lba z A/ i
Zip C/od Fax:
City: State_
Phone No. E-
Zip ode Fax:
Mail:
Phone No _7/z_
E-Mail f
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Sta or County License_
VO UC ua.una►rua.awn oa zauu or more, a nrl-uKutu notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address: _
City: _
Zip: Phone:
__Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inclicatea.
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 lanrior nr an attnrnpv hPfnrp rnmmencine work or recordine vour Notice of Commencement.
Signature o ntr - or - Owner Builder as applicable
STATE OF FLORIDA 1i
COUNTY OF 1— e
Swor o (or affirmed) anc� subscribed before me of ysical Presence or Online Notarization
this day of W Lam/ 20,by
Name of person making statement.
MARIA C. GOM:Z
`: 7 iorida
Personally Known OR ProducVd Identification ✓/ Notary Public - state o`
TT vo' COMMission x GG 29795
Type of Identification Prod l�
= _` FyQ; my Comm, Expires Feb a, 2023
Bonded through National Notary Assn.
(Signature of Notary Public- State W Florida)
Commission NO. S�Se81)
MA3 D. GOM,EZ
Nota y Pub.i: State o! F,orida
��y� ` Commission " GG 29795'
loaf.°: My Ccmm. �x:iires =eo 4. 2023
9onded through Na:ioral Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1U/12/21