HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO' MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:�
Building. Permit Application
Planning ond'Development Services
Building and Code Regulation Division
2300 Vlrginla Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential A -
PERMIT APPLICATION FOR: LL I L.'�rc,; r2(;`E-,
PROPOSED IMPftOVEM.ENT LOCATION:
Address: B5-bl �9A /�,f����., G'� X.e.L� , FL 3 `f 9�5-Z .
Property Tax ID#:
Site Plan Name: 54- /,*fio P4 G D'
Prniect Name:
DETAILE'D.DESCRIPTION,OF WORK:
New Electrical Meter Second Electrical Meter
I 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 Roof Pitch.
Total-Sq. Ft of Construction: Sq. R. of First'Floor:
Cost of Construction: S 41 &V � Utilities: —Sewer —Septic Building Height:
OWNER%LESSEE:
CONTRACTOR:_
Name D00JIVA *!'a 5ywin*4
Name: Dai,P
Address: &W 465.a&t,�u 61Arc40'.
Company: 9115ib�q �
City: NET ST 4"A4.r, • State: 61,
Address: 3 o 36 yam-4,1e:5-r Ie�f
Zip Code: �9.5?/ Fax:
City: M 14444t , State:�
Phone No. jf)!2 '_531 0 / 3 !2
Zip Code: � �3'� Fax:
E-Mail: J
Phone No' ?? 2,
Fill In fee simple Title Holder on next page ( if different
E-Mail o 44f5
from the Owner listed ' above)
State or County License 2,.r 7 /3
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.
3
m
N
v
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: ,r Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not 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, wails, 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. -
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa ure of Contractor/License Holder
STATE OF FLORII§A
STATE OF FLQRP A
COUNTY OF--1.�c�^�
COUNTYOF IG�
Swor to (or affirmed) and subscribed before me of
S rn to (or affirmed) and subscribed before me of
physical Pres ce or Online Notarization
20 2. by
hysical Pr ence or Online Notarization
day 20 by
ca
o -M
thisday of
thi of
/
NS
F.M
N a of person making statement.
Name of person making statement.cC
o
ly-E
Pe onally Known OR Produced Identification
Personally Known OR Produced identification
z g
e of Ide ification
Pr aced L
Type of Id nbfi tion
ProducedT-
QJ0�1C
n ^
i nattWe of tary Pe fed lie, State of Florida
(Signa ure of Notary Public- State of Florida)
>
alf0H.
commission# GG 269499
l mission No. coilSwOres Dec.10, 2022
�'� � � q )
Commission No. J (Seal
r
O
Z
IEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 516115