HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S5Vo U1CQLE
G
c ti 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-
�1V,
PROPOSED IMPROVEMENT LOCAT_,
Address: qs I Ir i
PropertyTaxlD#: N'SOZ loC,2 aus on (D
Site Plan Name: lay-wipu\ 1� l cWiYwwA%u KI OwiT % C I
Project Name:
DETAILED DESCRIPTION OF WORK:
Li\iS'TALL- i!V i; It`A PA T V'
Lot No._
Block No.
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: $ 21 1 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name L m A � Z.6 t'
Name: V-1 At? D6 to fVl A i,L A IJ A
Address: q F; oh S C rF A w D i
City: �>_ t�15 1�� tSf ACA- State: _
Zip Code: 3%Alc3 -1 Fax:
Phone No.
Company: MIF> CTei\1 ULr►o C-gCIVP L.LC
Address: ( e_ E
City: /'Ve-s'Cvt`i State: FL
Zip Code: S33'Z-I Fax:
Phone No q54 _ -::3"1 to - Q51l6
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail rm (C� 1 C V*1Qf9Qs - C.C,m
_TA
State or County License CC-C 15 1-7,1+1 9
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: 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:
Zip: Phone:
City: -
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 orrecordingWur Notice of Commencement.
Signature o caner/ Lessee/Contractor as Agent for Owner
Signature o c r/License Holder
STATE OF FLORIDA
COUNTY OF �'V . I AX icg-
STATE OF FL DDA
COUNTY OF 5T . Locl i_
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this -&-- day of 2021aiby
V. Cr'FL Lim AIVZAIL
t Physical Pres-once or Online Notarization
this ]o day of V—E99yA V-4 30Z9 by
[1Cfli2D0 MA-rALLA JPV
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification %c_
Personally Known '1 OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
V
� I -
(Signature of Notary blic- At f I r'
ature of Notar ublic- tate of Florida )
Commission No. �S or
ja Expires 11/tV
My m 24
Co fission No. J , °r
MY Commission H4H 08
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.