HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
CL-'
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Planning and Development Services
Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
PROPOSED IMPROVEMENT LOCATION:
A d %rA' Ir e%].-- s s :
Property Tax I D #:
zi�- Nw s aO�As� �r(vP.
4 ;�
805- �iU�l- GU(7-�
Site Plan Name:
Project Name:_ P (tv
. -Epi. q -t'l I hU Cc4'"'Ifv 0-C
DETAILED DESCRIPTION OF WORI(av
J1C�!
T' _if
t
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit"= check all that apply:
Mechanical
Electric
Tots! Sq. Ft of Construction:
Gas Tank
_Plumbing
Y11
Im
:��` 0
Cost of Construction: $ c,�-
OWNER/LESSEE:
Gas Pip ing
Sprinklers
Shutters
Generator
WEAMMMM
k.�' S[y. Ft. of First Flnnr-
Lot No.
Block No.
Windows/Doors Pond
r
f �1I,� �� Pitch
Utilities: � Sewer _Septic Building Height:
Name
Address: -P('
city: P (R 1+M i.1�-vim State: � UP
Zip Code: _ 34q, �(D Fax:
Phone No.
E-Mail: 0 0-tM. LOYVI
Fill in fee simple Title Hol er on n xt page ( if different
from the Owner listed above)
CONTRACTOR:
Name; Yee'#171U r "r�QI Yll�
Company: (LO 01(ih G SqSa-Evjiqr e-f, r—LvVrC16I
Address: 50 S 3 f oS�h
City: 9-0VgI Pulrvi 67Pa—C VA State: P La
Zip Code: 1 Fax:
Phone No_ SZ¢I-i�t5"-SS-(ofo
E-Mail admi nG mi,CID
State or County License
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.
CG2qSs':
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION6
.
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
city: 4 State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
NIORTGAGE COMPANY: _Not Applicable
Name:
Address:
city: State.
Zip* Phone:
13ONDING COMPANY: _Not Applicable
Name:
Address:
City: City:
Zip: Phone. 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 Count y- mal(eS no rep. esentation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with anyapplicable 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 aparoved plans. the Florida Buitdine Codes and St. Lucie County Amendments.
The following building permit applications are
exempt from undergoing a full
concurrency review: roam
additions,
accessory structures, swimming pools,
fences,
walls,
signs, screen roams 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 an the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or -an attorney before commencing work or recur ii . g vgur Notice of Commencement.
Sig4ature bf Ow"her/ Lessee/C�fitractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF V&-LM 6'.CjjClVw
Sworn to (or affirmed) and su scribed before me of
P ysical PresA--AL-4--
e o Online Notarization
ihis'�ay of202# by
IR
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Name Of person malting statement,
Personally Known / OR Produced Identific
Type of Identification
Produced �
(Signature of Notary Public- State of Fldrida )
Commission No (5�� 9'.7 .��� � (Sea1)
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AMW
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CD
Cr
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SignatOrd of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF LM_
Swrto (or affirmed) and subscribed before me of
Psical Presence or Online Notarization
this");qdayof 2024 by
Name of person making,sfatement.
Personally Known
Type of Identification
Produced
OR Produced Identification
(Signature of Notary Public- State of Florida )
Commission No&& 91cis � Seal)
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REVIEWS
FRONT
ZONING
SULW PLANS
VEGETATION
SEA TURTLE
MANtOVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REV
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/ZO