HomeMy WebLinkAboutBuilding Permit ApplicationAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
ate: Permit Number: i l� 1 •6010
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g ° .p - 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:=
ROPOSE:D IMPROVEMENT LOCATION:
Dress:
Iperty Tax ID #: ✓ 1119- 5,36 _ OZ/O - 00- 9 Lot No. Y
Plan Name: —���/ Block No. 32 /
hicrtAlama• l 1f11%
DETAILED DESCRIPTION OF WORK:
-,
,New Electrical Meter Second Electrical Meter
CQ.NSTRUCTI'ON INFORMATION:
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: $ /, 7 Ob� o o Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE- ;`
'Name
CONTRACTOR:
/'YI s ko' -De4�1
Address: //J %%E A,-�
City: 10'5 G State:
Zip Code: 0 Vq F3 Fax:
Name: 04m %62A�
company:%�.✓�sou�
Address:
City: /�s L -State: �L--
Phone No. 7 7-2-35i --- 7 Y5
Zip Code: 3 ��r5-
Phone No -7-7•--2--
Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
)WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
�t. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
vhich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
�tructure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
n consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
-he 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
NARNING 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 lender or an attorney before commencing work or recording your Notice of Commencement.
Sig ature of Owner/ Lessee/Contractor as Agent for Owner
igna ure of Contractor/License Holder
ATE OF FLO A
TE OF FLORIDA
COUNTY OF
COUNTY OF
affirmed) and subscribed before me of
Sw rn to (or affirmed) and subscribed before me of
sical Presence or Online Notarization
EF(or
ysical Presence or Online Notarization
day of f 2026 by
day of 2021T by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification C� .
Personally Known OR Produced Identification O/
Type of Identification l
Type of Id ifi tion
Pr uce
Produced
(Signature of Notary Pu I'
Florida
(Signature of tatgf lori��,
"4c N Public State of Flonda
/i Notary Public State of
Commission Nd— f , Wa oto
My gmssi0n GG 184727
N�otairyPublic-
�? Wanda SOW
Commission N 1( isslo n GG 184727
1112022
Expires 02/11/2022
OP F\
oPIFve Exp�r
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FRONT
ZONING
SUPERVISOR
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MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20