HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (.2)1 44 �_ Permit Number:
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Building.Permit Application
Planning and'DevelopmentServices
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: �loLrLo�
PROPOSED IMPROVEMENT LOCATION:
Address:(�A�y5U S.
Property Tax ID#:OE-Ua - of O Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: v
21
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 -?lumbing `Sprinklers —Generator Roof Pitch
Total.Sq. Ft of Construction: � Sq. Ft.of First'Floor:
✓
Cost of Construction:$_ 1 cJ�-{ t 71 00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name\(Ylk A-. 1 YY1 Name: ASLY-a S
Address:<' S. OSj2,,--� Company: �SkC c\C\ )(At \ C ,
City: D,y-w4o,r-\ 2:2 P` _ State: E- Address:tb ----+�5 S.
Zip Code:Z241�� Fax: I City:�Qy � � Stater
Phone No.�Q\b- o�l��' ��J Zip Code:22 - Fax:
E-Mail:Y-) is_ Phone No-+-+3-- (p - lli�alf't -4:742-aa� +sc
Fill in fee simple Title Holder on next page(if different I E-Mail ifyj , -b «
from the Owner listed above) State or County License \o�45 c�0:5Q5
If value of construction is 2500 or more,a.RECORDED Notice of Commencement is required.
If value of RAVC 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: 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,wails,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 attorne before commencinig work or recording our Notice of Commencement.
-AA /'
Si&zfdre of wner essee/Contractor as Agent for Owner Signatike of Contract r/Lice s Holder
STATE OF FLORqLlDpA STATE OF FLOR A
Al��
COUNTY OF ` >T l AJ,_PA P COUNTY OF E LA,,_ .i-P
Sw n to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization ✓ Physical Presence or Online Notarization
this 44.1.day ofrin(,y 04,=1 20J_,(_ by this day 202_1 by
nY1 k e -1-�:ic�D
Name of person making statement. Name of person making statement
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced nn,v n U'(Ca,\ ,P'c Produced
(Signature of Nota t goff Florida C}{gELRgpZ (Signature of Nota a of Florida}
CQm�tsslon#GG 318620
Co si * � l es July 28,2023 Co Issio ���"Y p;��c�, (Sdgf �•R"'
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.