HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Z( Permit Number: 2 C)
Building Permit App cation �
y F.
Planning and Development Services - 9 10
Building and Code Regulation Division Commercial ResidentidtcZ ,,° 01
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: otrR
P:ROP05ED..IMPROVEMENT LOCA;TI(O,N.:
Address: �f7YV J• VPC4N AIA• V V..Sf.N /3rc YJf75 /
P rope rty Tax I D #: YOZ-sbz-Do,1®- 000-;! Lot No.
Site Plan Name: Block No.
Project Name: OG4aIV4 / 1YQR*I
AI LED'.DESCRIPTION'OF-WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION 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: $ ��Q,G1D0, �D Utilities: —Sewer —Septic Building Height:
OWNER%LESSEE
CONTRACTOR:,
N a me GC0k4 / Cdv90 .4*vC l4lr 4U
Name:
Company: :5Ze,1c;!1Je
Address: 40. BDu A6A(e
Address: 99p0 S. OC&, w` ,Die.
City: 'AMA( IgE-AcM State: V&
City: oMeecl4d /;ew State: L
Zip Code: Iff r7 Fax:
Phone No. 77Z 7-29 30J a
Zip Code: 3 6q' ? Fax:
E-Mail: ihegSSl ie s`6/ 0�ail. CDC(
Phone No
E-Mail S??�r.�uQLo.✓�c>L. Cd.y!
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
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. I �(0'4
SUPPL ENI"AL CONSTRUCTION,LI:EN,LAIN INFORMATION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: Gfg FA1&Jy"&,y5
LLC
Name:
Address:08 SW OCZAA1
AkwQ•
Address:
City: T211geT
State: L
City: State:
Zip: „W91y Phone 772
r s �
2-AD %w
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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.
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
With Icndar nr nn nttnrnpv hpfnrp rnmmpnrino wnrk nr rpeordine vour Notice of Commencement.
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA q� tt
Lune,
STATE OF FLORIDA
COUNTY OF_���dC.
COUNTY OF
�
S n to (or affirmed) and subscribed before me of
or
Sworn to (or affirmed) and subscribed before me of
physical Presence or Online Notarization
'�
� Physical Presence or Online Notarization
is day of 1 2024 by
tlSis /i day of J.gw/ 2020 by
Name of person making statement.
nt.
Name of person maki:��Zrocluced
PersonallyKnown Produced Identification
Personally Known Identification
Type of Identificati
Type of Identification
Produced Z
Produced
u
(Signature 'Not Pu c- State of Florida)
Signature of Notary Public to Flo r ��, public State o1 Florida
���.• Shannon O'Donnell
Commission No.
Notary
No Ex�ISe rran Ob/13112022 323 248
�Vx Public Sue
Tiffany Lee Ferguson
of Florida
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Expires 10/10121124
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Itev. 5/ b/ LU