HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d - to -a I Permit Number:
c�V"
QD
IJI Building Permit Application
Planning and Development Services
'Y Residential
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
� � IIIbr;fG
Address: S 7 O I J
O� Lot No.---
Property Tax ID #:lg/Block No.
Site Plan Name: ,`O
Project Name: If Qa
DUA)LE,D,DESCRIPTIOXPFXQQK�
L/( -
u
n
S �
�
j��
New Electrical Meter Second Electrical Meter.
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters
i Sprinklers _ Generator
Electric v,\�C— Plumbing —
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Total Sq. Ft of Construction:
Utilities: _Sewer _Septic Building Height.
Cost of Construction: $
" S " M�� lt,l,✓v1
Name J
Address:—(
I a n,N1� 5-E-(1►(� Stat .
City:
Zip Code: Fax: L
Phone No.
eJe �
E-Mail: if different
Fill in fee simple Title Holder on next page
from the Owner listed above)
Name: -i �nr� va c�'-W- • '.'�-'C
Company: �� ` dk
Address:
City: S�- State.
Zip Code: �� QS� Fax:
Phone No -
E-Mail A
State or Co my Licensees
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:
Address: Name:
City: Address: State:
State: City:
Zip: Phone Phone:
Zip: __
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.
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 recordin your Notice of Commencement.
Signatu a Les ee/Contractor as Agent for Owner
Signaturk of Contractor/License Holder
STATE OF FLORIDA 41teu e
COUNTY OF
STATE OF FLORIDA R
COUNTY OF , S- `"" u
Swop to (or affirmed) and subscribed before me of
Swoj r to (or affirmed) and subscribed before me of
P ,ysical PresenSp qr Online Notarization
this jU day of -e t 202¢ by
Physical Presence or Online Notarization
this L day of +�ehs 4�. C—`1 , 2029
1by
Name of person making statement.
Name of person making statement.
Personally Known t/ OR Produced Identification
1
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
N
Radina Stoyano
�N�NNI& Radina Sto anon
rF
�
(Signature of Notary Public-S 01 037 9
E>�ires: Sept
Signature of N ry Public- St �;of is ) omm. H 319
•' 21,
Commission No. S�o�Iiled %Aam NYt�mission
24 Expires: Sept. 21,
No. �i,,, oo Sg d ThIv Aaron
�mun�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.