HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial Residential
2300 Virginia A venue, fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: `7 S t 1/ e O a- K - T -c G -C l` L .3 � 2
Property Tax ID #: D - �j O D 1 L16 --ODO - Lot No.
Site Plan. Name: Block No. a ,�
Project Name: : 'p— M D,
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: $ 67 00 eQ
Gas Piping
— Sprinklers
Shutters Windows/Doors Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: — Sewer _ Septic Building Height:
Name IS ✓e q v�
Address: 5. D S` l„ J ,r 0 a j{ p r _
City: r �' t State: L
Zip Code: 3 ,q Fax: ,
Phone No." 7 2'
E-Mail: A.16 -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: -74.-3:
Company: CDA4 ..t trlyffooa
Address: .2 3 rs' . 4, "e
'City: o',C��r _ Stater
Zip Cade: =a4 2y - Fax: 7 ?a- ,Vt �ifrr� _
Phone No 7? - (,/ & 'a?/
E-Mail TO 'L Q �i W ar4
State or County License re c .C15 0 J1
11 WCIUC %Pi 1616PI FULIJUn 15 6auvOr More, a KtWK1Jt1J Notice OT Lommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name:_
Address:
City:
Zip: Phone
INEER: -->-6 Not Applicable
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip- Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
u,ty: State:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
X Not Applicable
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 commencin work or recardin our Notice of Commencement.
L Ignature of Owner Lessee/Contractor as Agent for Owner Signature of Con ractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S� Lk-c-i COUNTY OF f ,'
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization Ix Physical Presence or Online Notarization
this /-) day of Make,. ft _, 2p2D by this -LJ- day of r 2020 by
Name of person making statement. I Name of person making statement.
Personally Known OR Produced Identification 1�
Type of Identification
Proceed TQ [._c�fSQL``�(00
(Signature of Notary Public- State rwyl
F °¢ CARRIE ELLEN IWAN
Commission No.� (} apgc� Notary Public State of
I} Commission # HH 021
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My Comm. Expires Jul 31
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced identification -+C
Type of Identification
Produced [- S lao a0 Uc�
ature of Notary Public- Sta
foa da 1�`Y "�°'> CARRIE ELLEN IWANKO
o ission No. i 3 d �c7� '.=° `r`f'� Public - State of Fic
2024 Commission # HH 02613
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My Comm. Expires Jul 30,
PLANS I
REVIEW VREVIEWON I
$REVIEWLE I MANGROVE
REVIEW