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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO_ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `� Date: Permit Number: OCp '03" Q 201 RECEIVED O - ` K° Building P �em i MAR 0 7 2022 . Pe'emit Application Planning and Development Services St.,Lu ie County Building and Code Regulation Division Commercial Residential ermitting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding PERMIT APPLICATION FOR: ROPOSED MPR01/EMENT LOCATION: �^ Address:- Property Tax ID#: Q I 6 3 9 zl-000 - � Lot No. 3 Site Plan Name: i AW C .V cvr— ( s,5.445: Block No. &-z Project Name: f?P-AnJe C_L S pA2/<S DETAILS© DE�SC«RIPTIU OF WORK: New Electrical Meter Second Electrical Meter (Affidavit required) . NINEN INF©RMATION: 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 Roo l- Pitch Total Sq. Ft of Construction: oc t Sq. Ft.of First,Floor: . Cost of Construction:$_J3 Y Utilities: —Sewer _Septic Building Height: /S OWNS /LE�S�SE : CINSITI TaR: Name_ 1.31ZAry C.r/U A-lzk"S Name: Address:686( company:L-efi,Ac_n . `Iv i �-C- City: R'e- ' P Ifit C-C- State: Address: (o$� 3 /3 4- Zip Code: 3 �.�' a Fax: — City: J State:�L Phone No. ���`y�'O �aSI E- Zip Code: 3 3`1 4 Y Fax: Mail: N4 A Phone No 31 S3 Y Fill in fee simple Title Holder on next page (if different E-Mail L �5 4,,,-iLv( cl;t4c5 CTa.- LG C ' ✓�'�- from the Owner listed above) State or County License CCC- 133 f C 6 4- 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. i SUPPL ENTAL C«ONSTRUCTlON IEN LAW INFORMATION: 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 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 lender or an atj efore commencing work or recording our Notice of Commencement. �iffkiature of Contrac -or-Owner Builder as applicable STATE OF FLORIDA COUNTY OF Swor o(or affirmed)and sui scribed before me of Physical Presence or Online Notarization this day of 20 _y Name of person making statement. / Personally Known OR ProduSpd4lea ification Type of Identifiction Pro ed L (Signature of Notary Public-State of Florida) Commission No. (Seal) ��",YPi�a" KAREN S. NIELSEN ,.� State of Florida-Notary Public Commission # GG 207484 'Foi'F`oQc MY Commission Expires June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10/12/21