HomeMy WebLinkAboutBuilding Permit Applicationy -
All APPLICABLE INFO M��USTT BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: V y Permit Number: 05l i
Or LLUC
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: S�q\ >( 1l0, aA✓'a--e- 5_1
Address: 5 1 5- '6 U G y1 R v\ ci vl ',l_--)R foYCT CQ .
PropertyTaxlD#:� '����®%. 0,2,�p Co
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrica
� I `&2.
Lot No. 18 qid m
Block No. 6
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: 2-, ) G-6 Sq. Ft. of First Floor:
Cost of Construction: $ 1� 2,60 Utilities: _ Sewer _ Septic Building Height:
i t 3i �`'r•;t .&°s' rvv :a:F.,,-tys'u ".-}dY �'Xi :i'Y-t {g$ .�y^:� j' '.; ! yi"1N+`...:.
° ,�, _ 0111 A; a
,OW'NER LESSEE r{=ts
J1'4 `1i�h:
t
Name, 0,VV4_5
Address0 VAavkoiCl
Company: ivi
City: State:
Zip Code: `yol 'Fax:
Phone No. '�-}2, 3 �� C; 3 2.3 ....
Address: ion: (...
City: O� ` Stater
Zip Code3g, 9 S 4 Fax:
Phone No
E-Mail:q-,_Vv_� S 2- CXV11t1
Fill in fee simple Title Holder on n xt page (if different
from the Owner listed above)
E-Mail n v�; �� '^r'O`` CIA -
State or County License
If value of construction is 2500 or more, a RECORDED Notice oT LOrnmencememt Is requireu
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPnLEtil ' TABCON'STUCT®N' L IENCAW
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DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
MORTGAGE COMPANY:
Name:
_Not Applicable
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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: 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
.eFitin lcnrlcr nr mn nttnrnPv hpfrirp rnmmPnrina work or recordiniz vour Notice of Commencement.
Sign ture of Owner/ Lessee/Contractor as Agent for Owner
Sigifature of Contractor/Lic , se Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ) l��
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed). and subscribed before me of
Physical Pres ce r Online Notarization
Physical Pres ice r Online Notarization
day 2020 by
this day of 2020 by
this of
11�iC� 7Ct ►��1
Name of person making statement.
Name of perso making statement.
Personally Known OR Produced Identification ✓/
Personally Known OR Produced Identification
Type of Idengf�ation
Type of Identification
Produced 4 �--
Produced
(Signature of
NotaryPublic- ic- State of'Florida)
(Signatur
UA< KAREN S. NIELS�EN�y-
Commission
F�� �F�,
.�ivRYP�s% II..
�N�o�a � Public
Commissi
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;State'of Florida-Notar �CU1 c
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# GG 20746�
�taKtevFF. or da
=* *E Commission # GG 207484
_iiissiun
9 Q°� M Commission Expires
' ,. OF FI.O� Y P
i� O�2022
REVIEWS
/ OFFS
June 12, 2022
VISOR
PLANS
,
MANGROVE
VEGETATION
SEA -TURTLE
10
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE '
COMPLETED
Rev. 5/b/ZU