HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: o 3
f 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
0 � �9
PERMIT APPLICATION FOR: � � �—� X 6 "'
PROPOSED IMPROVEMENT LOCATION:
Address: p 7
Property Tax ID #: _
Site Plan Name:
Project Name: ,__
q,
V --6? n 1 CL C
?,N b(9S6) DOD 71
DETAILED DESCRIPTION OF WORK:
jC9 0
New Electrical Meter Second Electrical Meter
L 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
Total Sq. Ft of Construction: ag Sq. Ft. of First Floor:
Cost of Construction: $ -/l�?`J Utilities: —Sewer _ Septic
Roof Pitch
Building Height:
OWNERjLESSEE: _
---9-
Name
CONTRACTOR: 1
-I
Name: - - L00 1
Address: �/ �v�c �yAB/11� Cj
City: ►" 7 A-' ---� State:=
Zip Code: Fax:
Phone No.
Company:-bo►k 00,'.afi�
Address: 1 5VAr"Ef
City: rT l,(ow State:
Zip Code: 3 Lt,?LI Fax: �rS
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ri to q-bi t 331 c-D Yl-dA no
State or County License CRC/� S S
If value of construction is 2S00 or more, a RECORDED Notice of Commencement is rlquired.
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:
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, 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/ Less e/Contractor as A nt for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
LVC.,
STATE OF FLORID
& LC' 2
COUNTY OF_4,. e,
COUNTY OF .
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
Pical Presence or Online Notarization
hysL
This Sday of �p/`l[ 2026 by
this day of 2020 by
s 1 4
Name of person making statement.
Name of person making statement.
Z
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced-,
^
(Signature of Notary Public- State o
of Notary Public- Sta o F
E,.� • Notary PubkC Stale
lX�c��� ryn any
Commission No.//��,,,, �r� Ka G Dr
+� My Commission G
Florida _
is n No. dd -011 No P S oiFla
�SU �P" in G Drawdy
2 . GG 2925
1ja ^ Expires 02/11/2023
MY Co ems
' f rtxrea 02!1 tf2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
.. PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
L,atev-ej
(Parcel ld#/Legal description/
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , 1 acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
�F" 4"r\
Property Owner Name (Please Print)
a
i�z44k" — 7- (
'
j6ner Signature Date
STATE OF FLORIDA, COUNTY OF S � LU C. L --P-
ACKNOWLEDGED�BEEFORE ME THIS DAY OF 1 JC�y 20 '2I
1 o BY Ben r for� WHO IS PERSONALLY KNOWN TO ME (0) OR WHO HAS
i�;�s]Zilfl.�L7
AS IDENTIFICATION.
/I -,Oak-F - ftj-'a� n
C
SIGNATU OF NOTARY PUBLIC TYPE OR PRI NOTARY
6r. .3 30 AiMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
Notary Public State of Florida
�P Ginger P Hester
my Commission GG 330259
�yawdd' Expires08125/2023