HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: rl' or d-) .1f'A 0R'2 Permit Number: C2 aO3 - 03Y-6
O
677
° 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:
Address: -11
Property Tax ID #:
Site Plan Name:
Project Name:
1" 0 0 -c..1 ✓ P> 0 7C f SOq
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
XElectric Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
Gas Piping — Shutters Windows/Doors " .—Pond
_Sprinklers _ Generator _ Roof Pitch
Address:110
Sq. Ft. of First Floo,r:
Utilities: _ Sewer _ Septic Building Height:
City: 7 State: -EL•
Zip Code: 3 -161 E l Fax:
Phone No. '1'12 5 7Gl ' Sa (v im% E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: -Aqhm &• liar fty,6�h I;I<-.i✓, L_LG, -
Company: ohm 64la4t,-on LGIc�l LG
Address: I a i 6-r_t,rn; S, ICI c.cl
City: S-ebc)-0; a 11 State:
Zip Code: ?)2gS8 Fax:
Phone No Inn ',�(,o To-'6
E-Ma9,,,/6kWkk)iu-y-ghut'J. r-un-1
State or County License jC, i AQOQS'g7
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.
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Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:DESIGNER/ENGINEER:
PhoneCity: State:
City:. State:
Zip:Phone:
FEE SIMPLE TITLEMOLDER: Not Applicable
BONDING COMPANY:
Name:
Address:Name:
Address:
City:
Phone:City:
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 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 posed on th jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an at rneV bj66re commencing work or recording our Notice of Commencement.
Sig t r of Cont r - or - Owner Builder as applicable
ST E OF FLORIDA
COUNTY OF,�,��.,A,
Sworn to (or affirmed) and subscribed before me of
Physical Presence or
Online Notarization
this day of �m 20o`±a by
Name of person ma Vg statement.
Personally Known OR Produced Identification
Type Identification Produced
(Signature of Notary Public- ate of Florida)
* MYCOMMISIVON#GG'275060
EXPIRES: December 20 2022
Commission No. (Seal)
of g,•
,
"ndedThruNctaryPublicUnderwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21