HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
o
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: Vav► a,,,,f�
PROPOSED IMP
Address:'
Property Tax ID #: "t (I 57 coo — ( Lot No.
Site Plan Name:
i
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Project Name: ?t0WVUf*U44ih�r
DETAILED 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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Constructio
Cost of Construction: $ $OL{ Utilities
N a me Sca.c na5r (!r" f-laa/VL GC.G
Address: L131Lt U./
City: 6a4n1-)977p State1a .
Zip Code: 333/ 7 Fax:
Phone No. 51Q
E-Mail: S (JC091-A' 2--W-17-z77� eonn
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Block No.
Shutters -4 Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
_Sewer _ Septic Building Height:
CONTRACTO
Name: [VkIGN1W-//(�Aj
Company: i2(>,,TVtAcr1/k
Address: 14 -c) SE
City: 4 :tL-- State: �2
Zip Code: �7 Fax:
Phone No Yt6 - o o(o o
E-Mail Ali/ L G lam- C e /'2&Mf'✓M— 7 L, C&A,
State or County License 1 4 :�2 T-Qr_
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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: F10440A WNIA.W AWv/A4Q2h11VU
_
Name:
Address: S6oi lMau,�Ar�S #,Zyo
Address:
City: ,4— State: F-t-
City: State:
Zip: _33`42a Phone I — 37y- gjrj f
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 Commenceme m result i a ice for
erty otice of Commencement st b r cor d i public records of St.
improvements to uFe�voflorrcimmencing
Lucie Coun ostite before the first inspe Ion. I y u in d tain financing, consult
with le er or attowork in ommencement.
Signatu f O n r/ Les ntr or as Agent for Owner
Si nat a of Contractor ense Holder
STATE OF FLORIDA,
STATE OF FLORIDA
COUNTY OF }fir Lucca
COUNTY OF
Sword to (or affirmed) and subscribed before me of
Physical Presence
Swor (or affirmed) and subscribed before me of
or Online Notarization
Physical Presence or Online Notarization
this Itficlay of , 202a by
this aC day of 2024 by
(yW Q, UO de -�-�
'%Y�,�c.1L+�•-2 ch.,
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
Produced
(Signatu ry Pu1SALS%tWdff161Nfifi)
(Signs
Stato of Florida -Notary Public
„u n,
=• Commission # GG 19 96
Commis Q,
Sion Exd ��'1
� � ri% State of Florida -Notary Public
Commi siiYn!i.1.9. # GG 192941S
1)
March 06, 2022
<in My Commission Expires
March 00, 2022
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