HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building.Permit Application
Planning and'DevelopmentSennies
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (712) 462-1578
PERMIT APPLICATION FOR
Address:
Residential Z
Property Tax IDit:: '/ /36 - -10 - 00 30 - 000 -(� Lot No. X f-o2
Site Plan Name: of dN1/C&-S/7Block No.
Project Name: .5 AMZ-
DETAILED.DESCRIPTION,OF WORK:
C
A;14 ! e - l 7 " /0 //) , d% l 14., j k,, % /,, /� iu 04eT FA-7 -7) _ LO AfC,
New Electrical Meter _J Second Electrical Meter�/4
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total.Sq. Ft of Construction:
Cost of Construction: $ �s
Lwinctix Citt_ Pond
_ Roof Pitch
Sq. Ft. of First,Floor: Y SQ
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR;
Name 2,4111/e/4 A- J0/f7✓50
Name.166 2,0/S DHA-AJe-Z
Company: tq&6 � � -Dog gS
c
SD
Address; P 0 BOX .S/ 7 yd
City:9/DW6//I/f a State:
Zip Code: d+ Fax: iY
Phone No. 35;D - rS 7 3
Addre :JS-f Sl�.f
City:b N P,4n/ li a
Zip Code: D (o d Fax:
Phone N��o�" �gJrCJ
State:-'
fiIAI
E-Mail: 3 'me ms/0.C6.^
Fill in fee simple Title Holder on next p ge ( if different
from the Owner listed above)
E-Maill�l O / I li ( / �-d - W r5.
State or County License G 33 /3
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
Inconsideration 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 lendl!roranattorngVbeforecommencigEwork or recordirlwyour Notice of Commencement.
� ��lc l�f�' ,
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,.fiGLG•"/d' i
Xgnafala of Owner/ Les a/Contractor as Agent for Owner
'Knat4tiCof Contractor/License Holder
STATE OF FLORIDA,
STATE OF FLORIQA
COUNTY OF titO�uc�r(�
COUNTY OF FSfCY fuYC�
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Pllyslcal Presenfe or/ —Online Notarization
�
� Physical Prese ce o Online Notarization
J.
this day of NO 2Q2 by
this day of Dn3 200 by
���v9J?S %CaMez c�
C ) u
Name of person making statement.
Name of person making statement.
Personally Kno OR Produced A ntifl tlon
Personally Kno OR Produced Identification
Type of fication
Type of Ification
P uce
Pro ced
(Si ture of Nota
(SI ure o Not Pu
-NRY RAMIREZ
Y RAMIREZ
Commission No N4GG 193970
CommissionISSIONOGG193970
BAPIRI'.SMarch 16, 2022
�ffE FXPIRESMarch 16, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.b/b/2u