HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
2'r-wm
a
°67Building 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 'i 1 d0 il)nr-I1n 414 I tom I4ol(?Win,nA-
PropertyTax ID #: 1q,),3 . 50d - M3,,5 - 060 --' Lot No.
Site Plan Name: Block No.
Project Name: Oeyw4 dyl
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _--_
Cost of Construction: $ J� ID 83,4 , iI I Utilities: —Sewer _Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name OL—la `� c�iriGlG
Name:
Address:J( 00 Mbtl AIA Jai
Company:
Tre
City: 24 nf)q . Lki49 _ State: r .
Zip Code: Fax:
Phone No.
Address: 810 T -
City:
Zip Code: 3aIto 5 Fax:
Phone No 6h1- o -
E Mail i
State or County License
Stater
,�M
� '
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
if vdiue yr cunszrucuon is cauu or more, a ntcvraueu rvance or Lommencement Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
E 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:
Zip: Phone:
City:
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 far 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 attornev before commencing work or recording vour Notice of Commencement.
)Sinat�ure
of ner/ ssee/Contractor as Agent for Owner
Sign actor/License old
STATE OF FLORIDA
STATE OF FLORID�1
COUNTY OF a J llni 0 �
COUNTY OF
Swo to (or affirmed) and subscribed before me of
Swo n to (or affirmed) and subscribed before me of
hysical Presence or Online Notarization
Physical Presen a or Online Notarization
this day of > 2026-try
this 202d. by
2( 5
21Z
Name of person m king statement.
Name of person aking statement.
Personally Known— OR Produced Identification
P onally Know OR Produced Identification
'Type o en , ,cation
_
Type o ft
Produced n
Produced
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Commission No. g�nd fuAaronNotary
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DATE
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COMPLETED
Rev. 5/6/20