HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J ZCLZ Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential_
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: eYOO Y
PROPOSED IMPROVEMENT LOCATION_:
Address: u
Property Tax ID #: . %O 1 - Z Lot No. -A
Site Plan Name: lh�Block No.
Project Name:
DETAILED DESCRIPTION OF
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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 5 Z Pitch
Total Sq. Ft of Construction: f, 32-c:) Sq. Ft. of First Floor: 13 ZD
Cost of Construction: $ '' 5W -CC Utilities: -Sewer Septic Building Height: ZO
OWNER/LESSEE:
CONTRACTOR:
Name
IP
Name:
Address.)I/
Company
V
City: (CV State:
Zip Code: q ?7 Fax:
Phone No. E-
Address: 2 -
City: State: )
Zip Code: Fax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail is
ecLtic f t P ma (r
State or County License Occ iy' -7 U
IT value or construction Is L]UU 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: Y Not Applicable
Name: T
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Y Not Applicable
Name: j'_
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:.
Phone:
Applicable
UWNtK/ LUN I RAL I UK AFFIEWIT: 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 attnrnpv hpfnra rnmmanrino..,..rl, n ....1:..... _ u..a:__ _[ _
Signature of Contractor - or -Owner Builder as applicable
STATE
COUNTYpFORIDA
Swot(or affirmed) an subscribed befpre me of
this day of
��b
Physical Presence or _Online Notarization
�
Name of person making statement.
Personally Known OR Produced Identification
_
Type of lde rodu[ed
,.�µ"•�� HAVENS
Cool,
^ MY COMMISSION aYHH1993e1-
�d. EXPIRES: DEC 04 2025
Bonde
(SAQLtu otary Public- St'A#e of Florida)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10/12/21