HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nm
ST. LUCIE
Building Permit
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
PERMIT APPLICATION FOR:
Address: 2635 South Brocksmith Road, FL Pierce, FL 34M
Property Tax ID #: 2320-501-0034.000-4
Site Plan
Project Name: Long Residence
New Electrical Meter X Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
JUN 0 3 2020
Permitting Department
iiCleI:1tl9llil'iP i nllnbi_ F=L
Lot No.
Block No. 3
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
_Electric ^Plumbing _Sprinklers _Generator _Roof Pitch
Total sq. Ft of Construction: 3655 Sq. Ft. of First Floor: 3655
Cost of Construction: $ 250,000 Utilities: —Sewer _Septic Building Height:
Name Wallace T Long and Lisa R Long
Address:2635 So Brocksmith Rd
City: Fort Pierce State:_
Zip Code: 34945 Fax:
Phone No.(772)370-1859
E-Mail:TobyLong53@gmaii.com
Fill in fee simple Title Holder on next page ( N different
from the Owner listed above)
f value of rnnetntrtin..'. icm...__ _ae,r r.�r..
Name:COml Builders
Company:
Address: •b • boy' laiuj
City: f I pfend'c State rZ
Zip Code: 3 q�'77'i Fax:
Phone No 2%Z— 370— I iS51
E-MailD6a, RI .e"-7
State or Counly License 4, O 2. -7
Ir—
If value of HAVC is $7,M or more, a RECORDED Notice of Commencement Is required.
!)r-�' 4i.��r ^\s..'..
WAS
DESIGNER/ENGINEER:
Name Raw R VAeVa 5 IGM
ry
Not Applicable
S s 'irt l •f�t1�fb�.[4"}}Y
tiN.-'. 9J(�
{'J,��W�;'T�"�E{�lhh,h ui
4.'ryt,,.l< 1k"i��h iLrV.l`t4�Ys"1�"•Y
MORTGAGE COMPANY:
Name:
x Not Applicable
Address:+58SE NaJaAv
Address:
City: Ponstcuaa
Zip:3M2 Phonemzwl-2 ,
State:FL
City:
Zip:
Phone
State:
FEE SIMPLE TITLEHOLDER: _
Name: WaDa®T LW9»nduae Rlmr9
Not Applicable
BONDING COMPANY:
Name:
x Not Applicable
Address:2ms se a,ammm Ra
Address:
City: Furl Pleura FL
City:
Zip:34945 Phone:wziaro-+ss9
Zip:
Phone -
OWNER/ CONTRACTOR AFFIOVIT: 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 priortothe 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 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: Yourfallure 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 recordine vour Notice of rnr rnPnr•PmPnt
as Agent
STATE OF FL
COUNTY OF
Sworn (or affirmed) and subscribed before me of
thishysical Presence or Online Notarization
day of `111��„ . 2020 by
Name of person making statement. �—
Personally Known V/' OR Produced Identification
Type of Identification
Commission q GG 337387 (Seal)
xpreE—l�s etIB22 2023
3oMeA Thlu Trov Faln Inrunnca 800-385.7019
REVIEWS I COUNTER I REVIIEW I SUPERVISOR REVI W
FRONT
Signatu oFComractor/License Holder
STATE OF FLORID
COUNTY OF �'� • CgU C ! 0)
Sw,m to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
thisdayof 2020 by
Name of person making statement.
Personally Known OR Produced Identification i/
Type of Ider*Ikation 0
VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW