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HomeMy WebLinkAboutBuilding Permit ApplicationA_ All APPLICABLE INFO MUST BE CC.... FETED FOR APPLICATION TO BE ACCEPTED Date/ �� `-��Permit Number: 0 V N§1 05%- Lull! c 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 PERMIT APPLICATION FOR: Address: 3 ®Q/ f 4' ff�C� ,�1 e-, Property Tax ID #: ;��`7 c L D u 0 6 0 d A 13 / 3 95?#7 Lot No. Site Plan Name: Block No. Project Name: _/ 2, Y 3 2 's �� 11. New Electrical Meter Second Electrical Meter (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 Total Sq. Ft of Construction: Sq. Ft. of First Floor: Roof Pitch Cost of Construction: $ ��©� _> Utilities: —Sewer —Septic Building Height: .3 Y 't i ; rtSlot kSY t ki 3 •t �f •�'y h: �¢i Ch qY : A" $F .TE r ..S � : e �f,.3 �..»e,�..# x � � .. �.h �' 2 o mi .�i dk ...� 3..� ...?A'. ti✓ �� i ?3 d S„4...*i•.:.a. �. 3� ...`�� . t W,^ .•�..t. �i.•Yw"P.K..: � �w �� i,.,a� �crm,. i �,-S� Name Name: Address: Company: : - Aress: ._ ....dd City: rc=�` C� Stater Zip Code: Fax: City: State: Phone No.' - 6 D 0 E- Zip Code: Fax: r Mail: r h-04 a4 i nex5el Phone No E-Mail Fill in fee simple Title Holder on next page (if different State or County License 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. 3 �iw ��, F. W t 3' 4�r 4rr��3El .Y6� J:f=•ii` 0`�}',•`, t ..�r :...,.,...,r.. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not A Applicable pp Name: Name: Address: City: State: Address: City: State: Zip: s Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable on BONDING COMPANY: XNot 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 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 attorney before commencing work or recording vour Notice of Commencement. ignature of Contractor - or - Owner Builder as applicable STATE OF FLORIPA COUNTY OF `.3 -- W c,�& Sworg to (or affirmed cl §ubscribed before me of Physical Presence or Online Notarization day 20"- this of Name of person making statement. Personally Known OR Prod uce�d�nt� ification � Type of Identification Produced cam/ (signature of Notary Public- of Florida) HEATHtH l; U Commission No. (Seal) ?�� ^ , tirotary Public -State of Flon� r\ .- _ Corrunissi.;n Nu � %n?moo Pvr C 91 1 o `S r,tP Y ornmissiol, . „ 89G I _1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10/12/21