HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number.
Z/o 3- 0�o7
91ro El_ M ed a 6 ► ��Iw1ad
O �uaw�
p ° p Building Permit Application ltiuti ° avw
Planning and Development Services 43�13�3�
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: q9 20 LJ�ukt Sovw. wrj FT Pirce Fl 3L09q
Property Tax I D #: 25 32 - 19 W - Qo-77 - Cho- O Lot No.�_
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
C Wttc r�� tt)�nc C�:.IIc�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $ 140()
—Gas Piping
Sprinklers
Block No.
Shutters _ Windows/Doors _ Pond
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _% mon}cS
Address: 1120 Wof}r-,'np" U2W
Name: QA-ZCAac V-U
Company: .JGE :4 1 nC.
City: K State: C- I
Zip Code: 3u'o1 qc 1 Fax:
Phone No.
Address: 212to '-#-J (IZwr 4:4"/e
City: V 1• w6 t State: C'1 i
Zip Code: 'StAOM Fax:
Phone No -77 52g -21 2cl
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail y OLV C\CC-'riC e "0\ eYWA'•)
State or County License 311LA$
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
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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, 1 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 ommencing work or recording your Notice of Commencement.
Signature of Owner/ essee/Co ractor as Agent for Owner
Signature Contra r/License Holder
STATE OF FLORIDA ++
COUNTY OF 7. L(,t f , `e
STATE OF FLORIDA /
COUNTY OF Sr �i-: Ci c:
Sworn to (or affirmed) and subscribed before me of
Physical Presence o Online Notarization
this j day of M a rL 202� by
SworrLte (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this �; day of J-V?';r(k 202JI! by
Name of person making statement.
Name of person making statement_
Personally Known ✓ OR Produced Identification
Personally Known / OR Produced Identification
Type of Identification
Produced �--
Type of Identification
Produced
Cam -
(Si nature of Notary Publi%' _ rid
C= Co+l�.#GGM14
Commission No.(�CLtS�EI�i ;; ( •Fob, 9, 2024
I�
&d Thra Am
(Signature of Notary Public- S. Wmrida
S.
-�_
Commission No:(�`1s r '�Y #669 14
• 4. 9, 20Q4
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 6/20 _