HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ 4LI714 io Permit Number:' O 6'
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
I. PERMIT APPLICATION FOR: p�Aq�N\" �Xacabe
Address: / %
Z' SL
Property Tax ID#:
Cup Q
Site Plan Name:
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Project Name:
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New electrical Meter Second Electrical Meter.
Building Permit Application
Residential
Additional work to be performed under this permit- check all that ap
_Meth .cal _ Gas Tank _ Gas Piping _ utters _AWindows/Doors
lectric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
_ Generator _ Roof'
Sq. Ft. of First Floor:
Cost of Construction: $ a Utilities: _Sewer Septic
—1
JUN 2 2 2023
ST. Lucie County, Pern
Lot No.
Block No.
_ Pond
Pitch
Building Height:'/�
OWNER[LSSEE w,
GC►NTRA6TOR
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Name au)-,66 \ fin\ U Q 5
Name
Address: \ l`l b,-je filet L-
comm3pany.
City: State:_
Zip Code: %\- Fax: 34`1 rj
Phone No. -1Tk- a,\ i3
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Address::,, I no
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Zip Cade:
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- — i' "State:_
Fax:
E-Mailer CiC��S �� I(dLOD .
Fill in fee 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 reguirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: = Not Applicable
Name: AV7e-4 I C r NC r
Name:
Address: PoG 0-0�
Address:
City:JE:•r— f rCj2c-4Z State: FL
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: _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 that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 a(I 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 no''rt-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
:.r, r,...a,... en n"r r.,oc k.fnro rnmmonrino work nr rprnrdine vour Notice of Commencement.
Signa re of wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF STL&4r
COUNTY OF
Swo n to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presencye or _ Online Notarization
Physical Presence or _ online Notarization
20_ by
this L'Z day of oJUAe,- 20� by
this _ day of
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Per Known OR Produced Identification
Type of Identification ..��JJ
S. �G
Type of Identification .
Produced
Produced r5� JAL,
(Signature of No
(Signature of Notary Public -State of Florida
Commission No.
Notery Publ
= - mmissi�G931632
Commission No. (Seal) '
Cg?F
93 JlP3
My Commission Expires
prII I November 13, 2023
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Rev.S/b/ZU