HomeMy WebLinkAboutPERMIT APP 4912 WATERSONG WAYAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '91 - I "S' -
Permit Number:
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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
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Property Tax lD#:
Lot No.
Site Plan Name:
Project Name:
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New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
—Mechanical V Gas Tank v Gas Piping — Shutters
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ L I (
Name
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: — Sewer _ Septic Building Height:
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Address:
City: State:
Zip Code: Fax:
Phone No. I i 4ri __ C. q 6, e-"' E-
Mail Vr_t� V,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: M k
Company: f-&' oz't vI
Address. I ( C, I -,A V(,-
city: i fVb F)ec4 State:
Zip Code: (J'16) Fax:
Phone No i Cr
E - M a i 1 0 C Y - V" S Ce�-_'� 0 vVC-,('LL) i (Clot
State or County License k_"�
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.
SUPPLEMENTAL
CtJNSTRUCTIC?N LIEN LAW INFORMATION,
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City:
Zip: Phone
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
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 aa-att='ey before commencing work or recording your Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
TVV
COUNTY OF IC (' V__
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this `1„ day of- wm ?i f 20 ��-by
Name of person making statement.
Personally Known %OR Produced Identification
Type of Identification ecl
{Pro
(Signature of Notar Public- State of Florida)
NICFtOLE MOORE
Commission Nolitj V11 53S (Seal)
Notary Public
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State of Florida
Comm# HH197538
Expires IIAVW25
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10/12/21