HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S-1 -z / Permit Number:
scIF-. LCL _ -
I Is 6 ri, ° G' � _ -` 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: NW JC�
PROPOSED IMPROVEMENT
/LOCATION:
Address: v 1 e� l �l C ��
Property Tax ID#: ru d q 000 -s Lot No.
Site Plan Name: Block No.
Project Name: 0/7/7 y r
DETAILED DESCRIPTION OF WORK:
/ C / ^ Z�W tl�
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 _PlumJbinng- _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: /O X Sq. Ft. of First Floor:
Cost of Construction: $ loy ' Utilities: —Sewer _Septic Building Height:
OWNS LESSEE: CONTRACTOR:
Name, e Name: Ul
Addres : 0 / t ���rcN �l Company•
City: /7 State.-ICI— Addres •
Zip Code: n Fax: 2 G. City: P&VM Stater
Phone No. l T r ZL,O 3 Zip Code: 0 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail /
6,6
from the Owner listed above) 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ 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,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
improveme your property. A Notice of Commencement must�re5ced in the public records of St.
Lucie C t7 d posted on the jobsite before the first inspection. Ifd to obtain financing, consult
wit nder or a orne before commencin work or recordin _oof Commencement.
Signature of Owner/ Fib`
r as Agent for Owner 'gnature of Contractor HolderSTATE OF FLORIDA / STATE OF FLORIDA rlCOUNTY OF COUNTY OF
S n to(or affirmed)and subscribed before me of S to�(or affirmed)and subscribed before me of
ysical Presence or Online Notarization .-ehysical Presence or Online Notarization
this y of y ZJZ this da of G Z y
Name of person making statement. Name of person making statement
Personal y Known OR Produced dentification Personal Known/�OR Produced Identification
Typ of dentification Type f dentification
Pro u d Pro ed
(Signature of Notary ubl(c� of Flor da<) E" �" (Signature of Notary-Fubftc-State'o `-
SHREISS BAUMGARTEN � , If iS a �h GARTCN
Commission NO. �i °� �� Mote{{52�th�tc Stale of Florida °/ �� Nota Pubhr ,l�lc of Florida I
ptr); Clmrms ton 11 GG 311842 Commission No `' �,` Commi io (SeaII)w,? i(
}AS rCi o.,,m es d � 1 ' Co Ei ^S 14,202
r 3
on al Nolnry ASSn.
Bonded thror.�h IJ,.twnal i:otery Assin ,?
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW _ REVIEW REVIEW REVIEW
DATE j
', antra BAu, G,�II r_ ;
Hot.'y f uhlu u- Sl o �loi u13 !,
RECEIVED 'I
DATE C nnmiston 77,
COMPLETED 11,2023 '
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