HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
p #PDD
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: J�4Atj L'ernb
PROPOSED IMPROVEMENT LOCATION:
Address: (P 03 r rc ' EC c,' 'r-k eaf. I..U.oG F1, 344t5A
Property Tax ID#:3��5-'1flS-4l3S-DOD•a Lot No. -t
Site Plan Name: Block No. o�
Project Name:
DETAILED DESCRIPTION OF WORK:
R yr �a s
i /� /� Ghd
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 X11- Roof / 1- Pitch
Total Sq. Ft of Construction: 16 •g 5& Sq. Ft. of First Floor:
Cost of Construction: $ a$ #SOd • Ott Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: G"t^.kem
Address:
Company: rr\tr `iY>
City: ?&r+ State: PlL
Address:3 tt
Zip Code: 35� Fax:
City: Po��E S� L� State:
Phone No. -7iv9 - Q1 q •-qp$$'
Zip Code: 340(5'a- Fax:
E-Mail:
Phone No -7a- 3 1 -
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License CGG
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
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indici ted.
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 cf 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.
At
nature o Owner/Lessee/Con ractor as Agent for Owner Signature Contractor/Licen a older
STATE OF FLORIDA STATE OF FLORID
COUNTY OF COUNTY OF `
SX.Q5n to (or affirmed) and subscribed before me of
Phy��s�' aI Presence or Online Notarization
this a ay, of 2021 by Name of person making statement.
Personally Known & OR Produced Identification
Type of Identification
(Signature of Notary Public- State
Commission No. 6 46 t& 51,39
NOTARY PUBLIC
STATE OF FLORIC
Comm# GG165138
Sw rn to (or affirmed) and subscribed before me of
Phy 'cal Pres nce or Online Notarization
thisg7,,Lwday of r 202# by
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signs Ore of Notary Public- State LaVna Ckht�edico
OTARY PUBLIC
Commission No.Gif /�ug� TJE OF FLORI
Commit GG16513
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE