HomeMy WebLinkAboutBuilding Permit Application _ I I
All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: Q ��cZ, Permit Number:
I RECEIVED
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J I FEB 2 8 2022
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Building Permit Application � St.LucieCOWnty
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Planning and Development Services
Building and Code Regulation Division Commercial Residential 1\
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 CBDG Funding j
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PERMIT APPLICATION FOR:
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Address:' C/ T K,4
Property Tax ID#: ��\d1' S �d�Od-4d4 » {� Lot No.
Site Plan Name: 1 Block No.
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Project Name: 4Z '^ v U G
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ffidavit required)
New�Electr�icalMe�ter Second Electrical Meter ( q )
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors Pond
_Electric _Plumbing _Sprinklers _GeneratorRoof- Pitch
Total Sq. Ft of Construction: 0 Sq. Ft. of First Floor
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Cost of Construction:$ ��,�U , fTCl Utilities: —Sewer -Septic Building Height:
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Name S AvJ tJ A 1A LL
s Name: 1
Address: USA •`C` L d �. Company:
City: LLAIt ou State: Address:
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Zip Code:,,g��� Fax: City: State:
Phone No. —7-- E- Zip Code: II Fax:
Mail: c' CV-A- Phone No J1
Fill in fee simple Title Holder on next page (if different E-Mail I
from the Owner listed above) State or Count License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is riequired. q
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: 1 State:
Zip: Phone Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: !Phone:
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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 ruses 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 site before the first inspection. If you intend to obtain financing, consult
with le_rWer or, torrftfbefor comrnencingwork or recording our Notice of Commencement.
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of 46ntr for-or- ner Builder as applicable
STATE OF.FLO ID
COUNTYOF
Sworn to(or affirmed) and subscribed before me of Physical Presence or ( Online Notarization
thisa,'4 day of 'mar 20�
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced 'F'L7ZJZ
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(Signature of Not - ate of Ftfi ate of Florida
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::r�`v G': Notary PubSion q HH 086359025
Commission No\� Fr (° ,Expires Jan Za,pssn.
°F '" thh National Notary
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Bonded
REVIEWS' FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED.
DATE
COMPLETED
Rev 10/12/21
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