HomeMy WebLinkAboutBuilding Permit AppAll APPLICAB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
CJ Lo LLL.FC[; C. ..-h.
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:�� -RP
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax I D #: l '" t
Site Plan Name:
Project Name:
A
Lot No. !
Block No.
DETAILED DESCRIPTION OF WORK: I
5Z2
New Electrical Meter Alit Second Electrical Meter
LCONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank —Gas Piping Shutters _ Windows/Doors _�J Pond
Electric _ Plumbing _ Sprinkiers Generator X- Roof / •f 4�.Pitch
Total Sq. Ft of Construction: ;2150 Sq. Ft. of First Floor:
Cost of Construction: $ (� � f Z)�) Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name e1AA?A-W ..
Name: A/a& %r-- &. _
Address: 117A-
Company: 74 C�%�(L1-S'eC�h�
City: e- 1�04rg State:
Zip Code: 43:3 TO Fax: Al 4-
Phone No. ��'l�` Z
Address�:W 117A ilpl Gc
City: 6"f !_ tate:��
Zip Code: �/ 77 Fax: .
Phone No -J5 3
E-Mail:�� 1 S f 7ZC� LcC Ci? 1r rCGrtt,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 1 tt--vGltl. !YIg1 f CU
State or County License C'C-C1j
It value of construction is 75UU 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:
Address;
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
UHVNEK/ LUNTRACTOR 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 commencing work or recording your Notice of Commencement.
Signature of owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 12 �'
S rn to (or affirmed) and subscribed before me of
is �P ysical Pre a ce or Online Notarization
day of _ IQt L — 202-9-by
ZQ& -21
Name of person making statement
Personally Known OR Produced Identification
Type of Identificati n Z
(Signature f a P JI' :- Slatg of FI rida
Commissio YP& ARLENE WILSONACiTT
ion # GGWM
w Commission Expires 06-28-2023
�i Conded Throuoh • Cmanolary
REVIE
DATE
RECEIVED
DATE
COMPLETED
Signature of Con{r*t&VL�ftVHolder
STATE OF FLORIDA
COUNTY OF i�
71sn to (or affirmed) and subscribed before me of
ysical Pres ce or Online Notarization
day of iL 202/1by
C eli:
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pubyi'c-Rate of Florida )
Commission N �nvar, ARLENEWILS49 11
ommission # GG 337161
a Commission Expirn5 Ofi-28-2023
- FRON [-- — ERVISOR PLANS
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