HomeMy WebLinkAboutPermit AplicationAll APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
0.
i r) Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential +�
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: z t� 2t t' b iZ. Sic r\s �
Property Tax ID #: 5 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
jA 1n:<< lllhCrL�}, �! I ) .-
r C-
I
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: $ 12. 0 n•n ••en c > Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �3i ' Name:
Address: 7 (ry r r n% ;2 • Company: kZJ U s k,
[ Address: , t'-'' V' rff l `
City: f' i� c State:
Zip Code: 4- Fax: City: 'G �`�� �`� state: �Ft
Phone Na l _ Zip Code: Fax: qS�f-
E-Mail: Phone Ncr9Q o
Fill in fee simple Title Holder on next page ( if different E-Mail a t{'Cf C �� � �• � ��
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
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 Countv and posted on the iobsite before the first inspection. If you intend to obtain financing, consult
with _lende n attorney before commencing worKor_recorain our Notice or uommencemenu
Signature of Owner/ Lessee/Contractor as Agent for Owner azure of ontractor/License holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY Of f� r wucl COUNTY OF 6 fe-)W4V3
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ��lay of 202f by
Name of person making statement.
Personally Known V-'_OR Produced Identification
Type of Identification
Produced
Sworn to (or affirmed) and subscribed before me of
i/ Physical Presence or Online Notarization
this jZL day of A t-A u 2024 by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
iRASEMAABDILL
;��yir$��•.IR,ASEMAABDILL
(Signa ore of Noate sisdat 24242t
tlonded
Ig tore of Nata y � tate��mfnCsLt�nidsc) 2a2o21My
Comm. Expires Sul 25, 2622
:� oFr�°'' My Comm. Expires Ju! 25, 2022Commission
No.thraughN
na Notary Assn.
Commission No. Banded throughNatio Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED