HomeMy WebLinkAboutBuilding Permit Application - 2176 Keen RoadAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
7
� ° ri 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
PERMIT APPLICATION FOR: IL��
PROPOSED IMPROVEMENT LOCATION:
Address: R Ze < �� \ �o G'�,
Property Tax ID#: I�113 -') C� - (D Go c,c 3
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
;cEl;�Wl PCW .40 a - leVe crric
n . w
av-VCA Q
-0QU A),
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:
Cost of Construction: $ 15-60 .,
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ' -k r �
-� .
Name: VIA'( P_ V1(esf 0
Address: I ")c� C11 R ne. fS V ho � A
Company: a l k COeL "! U-c*rr
City: �� 1)1 C /,(C_ State: F-7i
Zip Code: Gr Fax:�l91
Phone No. -7 72 -
Address:
City: PSL Stater
Zip Code: 3 LJ(IJ cA Fax:-%'2---) 9
Phone No 719 / l-6
E-Mail: -e k (,? j kaeloll-Q Co
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail % �G�11 eloe- , ('oDA.
State or County License L�C IgRg `�5�
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
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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,( or an attorney_ before commencing work or recording y1pur Notice of Commencement.
Signature ok+ner/ Lessee/Contractor as Agent for Owner I Signature of(Cantractor/License Holder
STATE OF FLORID , STATE OF PCORI A
COUNTY OFF e.>; r (irk C COUNTY OFCi*. t ! C/ C- / e'.....-
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this i day of / 2024 by
CA S w. 1 t V ..- L C ^- V co
Name of person making statement.
I-,
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of No6bry Public- State of Florida )
Commission No.
de Notary Public State of Florida
%, I Cheryl Fowles
xplres 04/11 /2025
REVIEWS
J9-71kC'V7C\AT
�
DATE
RECEIVED
DATE
COMPLETED
Sworn to (or affirmed) and subscribed before me of
�h sical Presence or Online Notarization
this /�/�da�\y Hof /y ,/� /,�2024 ///b✓��$99y
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
PAV X . C,2
(Signature of N ary Public- State of Florida )
Commission No.
Notary Pubhc StatejFlworida
Cheryl Fowles
P Expires 04/11/202
IOR PLANS VEGETA Kul«
EW REVIEW REVIEW REVIEW REVIEW