HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: I I L4 �1P WIP C_
Address:
Permit Number:
Building Permit Application
Residential
Property Tax ID #: _:15D2-" 5:70 1 .03c)(D , Cco • y Lot No.
Site Plan Name:
Project Name:
Block No.
i DETAILED DESCRIPTION OF WORK:71"- , r0c &OLI) n _Pki _ _ _a
v
lean. %to
New Electrical Meter Second Electrical Meter
I 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 1-1oof Pitch
Total Sq. Ft of Construction: i 2'lb Sq. Ft. of First Floor:
Cost of Construction: $ & Z5,av Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ��((IrY1¢� UanSGd1QU it
Name:
Address:
City: ' 110J State: 10 l I
Zip Code: - T"� Fax:
Phone No.
Company:i oyl&l Q
Address: tN jVi!(',f.
City (Jyo g p State:g___L
Zip Code: " jKz Fax-
Phone No .--F4'l LQ21 . �oZCD93
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0 C ry,-\
State or County License
IT value or constructoon is zsuu or more, a KhLUKutu Notice or 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:
City: State:
Zip: Phone
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 lender or an attorney before commencing work or recording your Notice of Commencement.
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Lgnatu of Owner/ Lessee/Contractor IQ�ent for Owner
S*ature of Contractor/License Holder
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TE FLORIDA
COCY
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STATE OF FLORIDA
COUNTY OF
Sworn,Wor affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
hysical Pr ence or Online Notarization
this 1 y of 2024 by
Phvsical I
Phypcal Presence or Online Notarization
this"2211dclay of. 202(l by
Name o(I persn making statement.
Name of person making state ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Typii,o �1�en '-'cqtion
Produced \t)L
Type of Identification ,
Produced
(Signature of Notary Public- ate f Florida j
(Signature of Notary Plub- S 0 o r i ra.7 blic SUft of FWft
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Commission No. (Seau, te Steie of Floricia
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Pamela
My Commission GG 985470
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Pamela Jones
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mission No. My Co�msjon GG 9eS470
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REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 5/6/20