HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLII BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 I Permit Number: 1
Uo LUCUIE "
- O
° TM Building Permit Application RECEIVEQ
Planning and Development Services MAX`4 9 1
Building and Code Regulation Division . Commercial Residential
Virginia Avenue, Fort Pierce FL 34982 Permitting
2300 Vir
9 St. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578
Property Tax ID #\,N PAkL lk% kaVS I01 11 111 .11 Lot No. Io, 13
Site Plan Name: Block No.
Project Name: O
DETAILED DESCRIPTION OF WORK: t�—\j Qe. GG�
= VI _ ati r„ Cr — R 2 O Seal A-t
�i00� . 1- PLA 5-J Pane l
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: I'Ct V ��� a J I Sq. Ft. of First Floor: d� J
Cost of Construction: $ 111 S00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name vv O�J:c,k.
Name: r
VQ. 1(C6k)W MC.
Address:q 161 S Lsn r: Se. NwO
Company: (A%rCkC%eA
&A,
City: P ►k cz State:
Address:' 43 10" PI
5 W
Zip Code: 34L1Fax:
City:\�ef0 bt-co'K
State: '
Phone No:1-1 ci.- Y) - ISI
Zip Code:--4-Q11(t) ,
Fax:
E-Mail: 7 6 JQMQA, I I COM
Phone No-1161, jL 11
l3'l
Fill in fee simple Title Holder on next lAge ( if different
E-Mail Mi LLncg,ll^jA.,e.`)`1a
from the Owner listed above)
State or County Licensek(r
a4o a15-1 q
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
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County d posted on the jobsite before the first inspection. If yo ' nd to obtain financing, consult
with leopMe ash attorney before commencine work or recordinG,v o e of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
gignature of Contractor/License Holder
STATE OF
STATE OF
61 � ��
COUNTY OF
COUNTY OFORIDA I . ,n�j
Sw n to (or affirmed) and subscribed before me of
Swo to (or affirmed) and subscribed before me of
P ysical Presence or On Notarization
P sical Presence or Online Notarization
this day of M%A�g . 202t by
this day of 2024 by
% 1014A81 1 U-
Name of person maki7stament.
Name of person making statement.
Personally Known R Produced Identification
Personally Known OR Produced Identification
Type of Ident' 1eation
Type of Identifieeftri
Produced
Produced Yam' 1. i--�i n n
(Signature of Notary Public- State of Florid
(Signature o Public- State of Florida )
Commi ip „ ,,, KAREN S. NIELS
Notary �
'���"" KAREN
Commission' `�t�Y°�a� S. NIE(lsg
�`_
�-
_■ *= Commission # GG 207484
_
_+F%rida-Notary public
9 o�c Commission # GG
;� sF fission Expires
207
June
2, 2022
Expir
June 1
s
REVI
SUPERVISOR
PLANS
NGROVE
COUNTER
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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