HomeMy WebLinkAbout4301 San Diego Ave Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .����lL'Permit Number:
'-LCIC
r 410
fL,t L k Building Permit Application
Planning and Development Services `
Building and Code Regulation Division Commercial Residential �J
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 4 -�(_A «Yi 1 e G (`; �'e
Property Tax ID #:
Site Plan Name: _
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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
Z. Pitch
Total Sq.. Ft of Construction: 1 (4 JIJ Sq. Ft. of First Floor:
Cost of Construction: $ J a I f j n Utilities: —Sewer —Septic
Building Height:
OWNERAESSEE:
CONTRACTOR;
Name £}
Name:
Address:
t
Company: fifib
City: 'Pcx _ P t`rc c
>>
State:
Address: ( r )
i 1
City:1 f
Stater
Zip Code: Fax:
Phone No. �, Cj
rl'
Zip Code: J �`
Fax:
E-Mail:
Phone NQ �0.
�5
E-Mail i' ' '' , i
Fill in fee simple Title Holder on ne page ( if different
from the Owner listed above)
State or County License
y
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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 jpbsite before the first inspection. If you intend to obtain financing, consult
,with lender or an attorney before commencing work or recording vour Notice of Commencement.
Sign fork of Contractor/License Holder
Si att&e of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF 5} . L,.-+C ,
Sworn to (or affirmed) and subscribed before me of
!� Ph sical Presence or Online Notarization
this � day of �,� ay—T i~ � by
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
this � day of 1" [, Y%Z 202G-by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ��
Personally Known OR Produced Identification
Type of Identificatiorl
ProducecL
Type of Identification
Produced
r" l
�% Y�
(Signature f otary Public- State of Flo r'
Notary Public
Commission No. �� ��%G-'�°�� —State of Florid
Comm# HH
Expires 6/3/20
(Signature of Notary Pu lic- State of F Krys� �feec
Notary public
7?mmission No!� N L"r1 e state of Florida
4 ', Comm# HH
l0 006757'.
2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20