HomeMy WebLinkAboutpermit application.All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SctITC, ri-U CG of
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:
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Address: r��[�-2- POIn—t l7r
Property Tax ID #3LAC>2 • (pC>- 0 t-JQ 0QQ ' `4 Lot No. -2-
Site Plan Name: -=X tICW7) 1(lver Block No. 0
Project Name:
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C=42kQLC-5= LiI C>00
tIzvq # 20 •0go • 25
New Electrical Meter Second Electrical Meter
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: $ n3_{ , C>�C> Utilities: —Sewer —Septic Building Height:
Name Ln Ap iS Corp C) FI
Name: $ I> CGL0_JC; e_ G1cor-S
Address:a0t N YiilPoin� (2KWA Sir-310
Company:71
City:LAXS+ PCOVY) JOCGCG State:F1
Address: L435 E0AT_-r -C d�
City: P's k State:F1
Zip Code: 33�40" 1 Fax:
Phone No. 710? • L-ok-t' 1Q12.
Zip Coder -Lai l,o Fax:"r 7. q Lo0'-7(P,'Z
E-Mail:
Phone No-"1'-12 . L-Kol) - ILP
Fill in fee simple Title Holder on next page ( if different
E-Mail 6 , S r✓ as Gt1-Q O I!S
State or County License 3i521
from the Owner listed above)
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.
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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:
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 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 our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Sign Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 2�4-. L V n e,
STATE OF FLORIDA
COUNTY OF -15-+. Lei L
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thisML day of 2020 by
Physical Presence or Online Notarization
this o ; day of 6 /-J`unt , 202f by
Name of person making statement.
Name of person making statement.
OR Produced Identification
erso�iation
rsonall Know OR Produced Identification
Type
Type of Identification
Produced
Produced
r�
(Signature of Notary Public- State, M; vjda ) MICHAELWALZAK
r . , o
Commission # HH 09799
Commission No. rSea�xpiresFebruary2,202
'11FOF W-0 $Wed Thm Budget Notary Sery
(Signature of Notary Public- State p Florida )
t� • * MICHAEL WALZAK
r° •'' '`•��' ion k HH 087991
Commission No. * * ee"a
„ o� ' Expt February 2, 2025
�ZO1 F�oP\ Bonded Tin Budget Notary Servim
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20