HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: ' 1 Lem Permit Number:
RECEIVED
LCUC��
6-
cro PEAR 17 2022
Building Permit Application
St,Lucie County
Planning and Development Services PPormitt'ng
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: e n c� n
Property Tax ID#: -- � Lot No.
Site Plan Name: Block No.
Project Name:
nt
••-e,q. MM-1-
gg, - g
Y - -NO—,@> :
-
N0-1A o -2
1_
New Electrical Meter U ond Ele trica I Meter w (A�ffi it re wired)le r
.`- _
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 _Roof Pitch
r
k-%Oe*l '
Total S-q-t o7Construction: 1.111bi �"� Sq.-Ft. of First Floor:
Cost of Construction:$ (7oC)• itc — Utilities: Sewer Septic Building Height:
'c s
Name ' Name: yM�
Address:— Company: In IIA (ad
City: E-6tit State:j, ( Address:
State:
Zip Code: City:
Phone No. -7 J �(=-7°i Sb Zip Code: Fax:
E-Mail: a `>t ) 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 Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGA COMPANY: Not Applicable,
Name: Name: 0
Address: Address:
City: State: City: State:
Zip: Phone Zip:i 054Phone: 1•- '9 1-7 o-744 -A566
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 or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 attorne before commencin work or recording our Notice of Commencement.
Signature/oOwne-r/Lessee Contractor as Agent for Owner
STATE OF FLORIDA (� .
COUNTY OF ) � .a, C.
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this 17 day of 20Q�by
��da _
Name of persbn making statement.
Personally Known R �uced Identiiificatio
Type of Identification Produced LL
(Signature of Notary Publi State of Honda
Commission No. (Seal) �p�._ AUDREYB.HUMPHREY
I a''coMMISSION#GG 300817
EXPIRES:March 6,2023
d;rum lud Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 2