HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SIT,, GC CEIRE, `V
�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:
Address: 3-12.5 SC1ry� tacg=- G'T
Property Tax ID#: 3L-t25 •—IOlLD - 02(o3 • 000 - 2 4^ Lot No.�0
Site Plan Name: pe. GI, <nnyOnn01 Cal tb Block No. 52.
Project Name:
r�oacc. 12 1/11-1 DPI'?'>
11 )n --w -z olcto 1 -25
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
Sprinklers
_ Shutters _
Generator
Sq. Ft. of First Floor:
Y Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name 1-tCAICOICI {-k=3- l
Address:23-125 cn 1QCG. C+
City: r S � State: EL
Zip Code: 3X1g52. Fax:
Phone No.'rl2 • -1? F5 • Le SAX Lo
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: LOf nli& tifaCQ-
Company-D ,kC:>Gc [CG1Qe, aQQ(S
Address: Lk35 t-� G-LD iS-r- Dr -
City: State
Zip Code: 3ti-4G18 to Fax: -M •L-UpD•-l(p35
Phone No -T Z • L-t(c>0 •--I ip.30
E-Mail e-D10E;CJg2Cvd0ofSPSI -CC
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.
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
wilb,lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor a gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S«= 1-vC=e
STATE OF FLORIDA
COUNTY OF 'J %l:6t
X-
SwornjtpzsT-affirme d subscribed before me of
Srcal PrPELe&& rerc,r Online Notarization
Sworn nd subscribed before me of
hysical Presen or Online Notarization
this day of f�teitt� 1 2024 by
this ay o ►�6��� 1 2021 by
Name of person making tatement.
Name of person making statement.
Persona ly Known OR Produced Identification
Personally Know` " OR Produced Identification
Type of Iden i ication
en i ication
Produced
Produced
a
(Signature of Notary Public- State of k*kW,) MICHAELW
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(Signature of Notary Public- State of Flori
MICHAEL WAL
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Commission M HH 08
E*esFebruary 2,
Commission No. � a9r
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991 ji �(� C{ a '`..... Commission # HH
0EDrnmission No. 1� ``'974 F 1
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FOFF�o�� sowed Thrubudget Notary
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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