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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONF- All APPLICABLE MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (INFO f Cl ` ROL9 Permit Number: Date: 219. L. -0 RECEIVED JAN 19 2022 ° .� ...• . °` ,. Building Permit Application St. Lucie County Planning and Development Services Pe miffing Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR:. Address: iri Property Tax ID #: �V10� ��a"0�d� ^ Lot No. Site Plan Name: Block No. Project Name: Al H­ 01 IM - - LLB,. . w� 011.ml �N 5r/4 a . sY1 Z°C) iJViG�y rti1 x ao� New Electrical Meter- Second Electrical Meter (Affidavit required) 4 . r .,xvs ,.1._ -y - r g 0 MNN -1�e gMnR Additional work to be performed under this permit - check all that apply: Gas Tank Gas Piping _ Shutters. Windows/Doors _ Pond _Mechanical _ _ _ Electric _ Plumbing _ Sprinklers _ Generator — Roof' Pitch Total Sq. Ft of Construction: a S.� Sq. Ft. of First Floor: Cost of Construction: $ at i;ZpC� Utilities: _ Sewer _ Septic: Building Height: J Pe 41 - - r LLName - DF}G+' ietA STfne Name:' Address: 5 j©D R VI"eTreDr Company:''.. .. •, „1 e ., ., City: �?`'. P� �t�c-� State: F1, Address: City: --- -• State: Zip Code: Fax: �- Phone No. 07©0-1 " 6� - '?3 r Zip Code: Fax: E-Mail: &A-►►1ieh P VQ(/ V)b0,-e15Wl 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 Commencementis required. AMA low DESIGNER/ENGINEER: ANot Applicable MORTGAGE COMPANY:p _ 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 &� and coven'ants'that may restrict oY prohibit such structure. Please consult with your Home Owners Association and review your -deed ;for ar y,restrictions which.may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, performthework 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 attorneybefore commencingwork or recordin our Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF S�r , l'�,e Sworn to (or affirmed) and subscribed before me of _ Physical Presence or Online Notarization -this \0% day of 2d�a' by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced w %N 0 <. D �- (Signature of Notary blic- State of Florida Commission No. 3Sq DEAN AA.QGIV NS of Florida Publlc��St a Commission # HH 086359 :FOF�, My Comm, Expires Jan 28, 2025 Bonded through National Notary Assn, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION.-, SEA TURTLE:,.: MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW .,,.,REVIEW,, REVIEW DATE RECEIVED DATE COMPLETED Rev S 21