HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11l6f Z? Permit Number:
�4 d�CUE
O ti
°D 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 APPLICAI ION FOR: ' COI r�r
PROPOSED IMPROVEMENT LOCATION:
Address:
Proper tyTaxlD#: 41liFl-P�C� Lot No.
Site Plan Name:
Project Name:
Block No.
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New Electrical Meter Second Electrical Meter
Additional worl<to be performed under this permit —check all that apply:
_Mechanical
_Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction;
Cost of Construction: $
Gas Piping
_
_Sprinklers
_Shutters
_Generator
Sq. Ft. of First Floor:
Windows/Doors _Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
,
CONTRACTOR:
Name lk (1Gz
Name: L a L'1 C
�cL
Address: 6i"7'{ p
Z-
Company:
City: J-cafl' Vr�se�
Zip Code: 3y-`yi 9 51 Fax:
Phone No. J [ L &I � '
State: L
.3� T?
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: Ibo, c& (e% 4 ( ^Je, COM
Fill in fee simple Title Holder on
from the Owner listed above)
next page ( if different
E-Mail
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.
LIEN LAW
NGINEER: of Applicable
IN=Phone:
NY:
✓ Not Applicable
ONTALCONSTRUCTION
Y:
Name:
State:Phoneone:TITLE
�ot Applicable
State:
HOLDER: 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
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
structure, Please consult with yolur Home Owners Association andrreview your deed for any restri tons which may alprohibit such
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
co f St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing,
,..,...ult
,,,i,r ninti�o of Cnmmancement.
with lender or anatto�rnpe before comrnencui wul Litu
-- -
/X \
for Owner
w A
Signature of Contractor/Licen�e'HId
o tractor as Agent
Signature of Owner/ see/
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF Lss i
Swoy'n to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
!✓ Physical Presence or online Notarization
Physical Presence or _Online N2oUtallotaby
rizationthis
IR day of�� 2024 by
this y of
Name of person making statement.
Name of person making statement,
Personally Known V/OR Produced Identification _
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produ ed
(Signature of Notary Public- state of Florida )
( ignature f�f , A'ill9 LE
tins
i,t �'f
,WARM 05
Commission No. (Seal)
Commission No. _
a xplres� PH24
to oil
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6j2U