HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
0 -1-111 0§4
Commercia
CBDG Funding
FEB 15 2021
St. Lucie County
Permitting
Residential
Address: IDWO S. OC-FAW OWE TgNS9144 ge", FL 3 gtJ5 7
Property Tax ID #: 4511- S14. 000 z - 000 Lot No.
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Block No.
(Affidavit required)
Additional work to be performed under this permit -check all that apply-
M,ec.hamical Gas Tank- Gas Piping Shutters
Ei'6"ctrib,"-- '4'Plu"nibing , Sprinklers Generator
Windows/Doors Pond
Roof Pitch
Total Sq.. Ft of.Cohs'truction: Sq. Ft. of First Floor:
Cost OfConstruction: $ Utilities: —Sewer Septic Building Height:
MAP,!, Av
Name PWall'Aft4o"A C.
Name: i
Address: lostio S. O"as RP4G
'JQ`6mpany:
City: Tt"Se* azqcjs State:-4
Zip Code: 3Yt$7 Fax:
Phone No 791- 794-1112-3 E-
'Add rbss:
City: State:
Zip Code: Fax:
Phone No
Mail: /A -A,- C45,
Fill in fee simple Title Holder on ne k t page (if different
from the Owner listed above)
E-Mail
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.
HN''I
.,.
1.411
wo.
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
tt Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Ph"one
Zip: Phone:
FEE SIMPLE TITLE: HOLDER:
J Not Applicable
BONDING COMPANY:
it 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 thatd§,glranting a`Permit:will';au;thorize;the per,p-lit holder to. buil the,subject-structure
which conflicts with any applicable Homeowners'Assocfatlon'rules,'bylavws or and'covenaht"gthat m�yr'estrict 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.th.e�job.site before,the,first inspection., If you intend to°obtain fin-zIncing,,consult
A+h In 4r r r nin n++nrn` ' Kofrira !'n'rY1n'iPnri`r;a Uinrl< nr `rer(.Ml � vour'Notice of Co'mmelicehlen'
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF V�lCtr-1Y�
Sworn to (or affir ed) and sub cribed before me of
this day of i., _ 20� by
Physical Presence or Online Notarization
Name of person making statement.
;z`1�YP`B�-. Notary Public -State of Florida
Commission # HH 218910
<_
°� My Commission2 26res
°�p;;�`�
Personally Known V OR Produced Identification
February o6,
Type of Identificati duced
ignature of Notary Public- State of Florida)
Commission No. (Real)
Notary Public State of Fiorlda , r
Katherine .Catdero
My H 183049 °n , .., `
60. V2812026
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEAT,U:RTLE ,
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21