HomeMy WebLinkAboutBUILDING PERMIT APP (1) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SM L L c L G
J -
`' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 570 5 VL_ q5
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
C � o-- �f�2-f 2 S�a le. Fo,,;I�:t �xs�a9nce,
New Electrical Meter `� Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
LWechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _ Pond
Electric L-Mumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: ot, q,-k5 Sq. Ft. of First Floor: a)91 S
Cost of Construction: $ a ALe.oo� Utilities: _Sewer .optic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Chr;s-6p►-v- v^d\ &-la--;o- GI oar-l; Name: 5d... A. (11w �_&-
Address: M I S 19'u' ike . Company: rrvuza &uld.0r( ma, c,
City: Vxw State:F_I-• Address: Sl l PStd (31J d,.
Zip Code: 3otq� _ Fax: City: P SL State: FI _
Phone No. ` J Zip Code: 3M53 Fax:
E-Mail: G logy%(L rv\a.�l o�yv-nc� I C'00 Phone No -I'1'l: 336- -71953
Fill in fee simple Title Holder on next page( if different E-Mail -Tomi ;i) �vozabu, J_ S. Cs'v"—
from the Owner listed above) State or County License_ 4--7 2`
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: 'b• Name:
Address: Gl0 (Tr-",& Address:
City: cw-�- State: City: State:
Zip: J,-ko l Phonej2p Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: -4 t 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, 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 lende r an attorney,before commencing work or recordiog your Notice of Commencement.
Signatu e of Owner/ ssee/Contr ctor as Agen for Owner Sig ture of C ntractor/ cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF S,
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this ►c) day of fx\gqr 220 by this Io day of YV\CL%A
0
/� -a
�1�.�. .�. �s-viz-Z-� �`�4� �•��(Yr r�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Producedp Produced
(Signature of ary Public-S f Florida ) (Signature of Nota4 Public-State Florida ) Kelly Finley
Kelly Finley �, Notary Public
Commission No. }^{1-y6$as� (SeVNotaryPublcCommission No.�{ l7 -AsQkP �St;,tzofFlo d
State of Flo da 2 Comm#HH R 82506
0*"E M' Ex Tres 1/ 9/2025 'IN 11 p res l
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.