HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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L l_ `i `` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phare: (77 2) 462-1553 Fax: (77 2 ) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
ddress:
PropertyTax ID #: 21-4-3 Ce 2. L- — Coo?j ' QOL^ — Lot No.
Site Plan Name: Block No.
Project Name:
I 'DETAILED DESCRIPTION OF WORK:
New Electrical MeterSecond Electrical Meter
CONSTRUCTION iNFORMAT�ON:
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ zfbo Utilities: —Sewer _Septic Building Height:
I OWNER/LESSEE:
CONTRACTOR:
I Name -r Q O,- IS
Name: Lk -n Q --
Address: uJ M S bO{ C- t �- G e
Company: "C— a, S� I Q CI-/� Cr -xo-L
City: �" � State:
Zip Code: �� Fax:
Phone No.
Address: Lo D 1 !3 �Q A els e -
City: � I, 1 P Q (� State: L
Zip Code: a>y-1 SZ- Fax: -772 447' 13sy1
Phone No "T 7 �L
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail-) , nL S3 2
State or County license leL OOo
L...,.,... — -3--, - --a csi J$ mquiran,
If value of HAVC is $7,500 or more, a RECORDED Notice of Contnleflcstll W l3 rrquir@i.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable I
Name: Name:
Address: Address:
city: State: City: State:
Zip: Phone Zip: Phone: i
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable _
Name: Name:
Address: Address:
City: City: j
Zip: Phone: I Zip: Phone--
OWNER/
hone: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 alt 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 YOUR PAYING
TWICE FOR IMPROVEMIENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECWN. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee Contra as Agent or Owner
STATE OF FLORIDA�V
COUNTY OF >>
The forgoing instru t was ack owledged qaefore me
this l day of ,
2t�Uby
Name of person making statement.
Personally Known R Produced
n
Type of Identificatio`
(Sig ture of Notary Public tatkofF((Jrida) "" "'L "
amm $. +on 9 GG 18716
Commission No.F e March 14 ,2022
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REVIEWS I FRONT IZONING
COUNTER REVIEW
RECE;VFD
DATE
COMPLETED
Signature of Contractor/License of
STATE OF FLORr(&
COUNTY O1
The forgoing %fent was cknowledged before me
this 9y zy
Name of person making statement
Personally Known �R Produced
Type gf Identification /Z
{�ature of Notary -F -66u lic- State of Fla
Commission No.
ida
{SL$aI} -0 14, 2022
- 78z:6,'
SUPERVISOR
REVIEW REVIEW ON 15EATURTIE REVIEWMANGROVE