HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAIL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTI Q • I
Date: DC Permit Number: I I`Jj
I,2°j I.y SCANNED
O Q°l �� `V" L115 J�%j a Y RECEIVED
St.luciefount�l
Building Permit Application DEC 2 9 2021
Planning and Development Services St. Lucie C my
Building and Code Regulation Division Commercial ResidentialP�`m g
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: � M,WYAVI 1'k G\Vn.
Property Tax ID#: a(f a.s" (DOI " d 1q,5— 0 On' Lot No.
Site Plan Name:
Project Name:
Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical
Electric
—Gas Tank
Plumbing
Tota"Fiaf nstructtgu 6
Cos .-fsq_RStru`ct
_Gas Piping
_Sprinklers
Block No.
(Affidavit required)
_ Shutters —Windows/Doors _ Pond
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNERJI ESSEE� r 4 h j +<
GONTRAICTOW 11 , w' ,4 !:
am
,7,
Name:
d d ress:
1 J
Company:
City: I y FL State: I/
Zip Code: 3-q% R Z . Fax:
Phone No. Z 2Z q E-
Address:
City: State:
Zip Code: Fax:
Phone No
Mail: Or
F.ill'- . - b simple Title Holder on next 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.
j
DESIGNER/ENGINEER: —
Name:
_Not Applicable '
-MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITL•E'HOLDER:
Name:
-_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Assbciation and revtewyour 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 attornev before commencine work or recording your Notice of Commencement.
r - L -tra r - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of _
Physical Presence or _Online Notarization
this day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public -State 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