HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 12-22-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: 2 Permit Number: �� �& - un .�(
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Building Permit Application. lZO�Z 99330
Planning and Development Services a3^I�D�a
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Un Ing
PERMIT APPLICATION FOR: ��� -�6
Address: S�2 0 7 jj9�jY� Z4-
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Property Tax ID #: 7� (�/�. b 4 n O O Lot No.
Site Plan Name: Block No.
Project Name: -- L
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing / _ Sprinklers
Total Sq. Ft of Construction:. !�
a
Cost of Construction: $
(Affidavit required)
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer Septic Building Height:
.-v.t .yis ur�,e-4 C _£,6"' °rr �e iyc.pC
OV�INER/LESS
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Name
Name:
Company:: i� ,ei s./�•
Address:
City: O if �'P'� r .... . ... ..:.:- State: /CL
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Add ress: 7 y�0 �.S'E �Dt/,S' a� e� ✓�/'�
State:
Zip Code: / -7 Fax:
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Phone No. �L
Zip Code: Fax:
Phone No %-;�� �� y
Mail:�A40OX i( &&/ 40 CIM-47, -C of
Fill in fee simple Title Holder on next page (if different .
E-Mail
State or County Licens �r a S-9y3 Z
from the Owner listed above)
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.
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DESIGNER/ NGINEER:
Name: .5 n%r
_ Not Applicable
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MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: ;06
s7e
Address:
City: ru .4State:
Zip: Phon Z (o %Z
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AF'FIDVIT:'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.
cl County and, posted on the jobsite before the, first -inspection. If you intend to -obtain financing, consult
�e,irli larnriar nr/In attr;yfS�.hPfn�P rnrr�pnring woilE or'recordine vour Notice of Commencement.
Si ature of Own r/ L see/Contractor as A or Owner
STATE OF FLORID
COUNTY OF
Sworn to (or affir d) and subscribed before me of
Physical Presence or Online Notarization
thi Ali of Q,C. 201 by
`day
V
Name of p son making statement.
Personally Known OR Produced Identification
TyKfIdentification Produced F1•. ��
,
(Si tur of Notary Public- State 9f Florida)
1ASHMNAINGRA�BcemM-RAHMINQ
Commission No. (Seal)
i:, MY COMMISSION#GG275060
2 2022
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"c Underwrdtets
gp�dedEXplThrU Notary PubG
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
.COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED'
Rev 5/2U/21