HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: S1 1 a` Permit Number: J
940 MAY v91021
C O Permitting Department
Q _ Building Permit ApplicationSt,LucieCounty
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce F134982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 122200.E
PROPOSED IMPROVEMENT LOCATION:
Address:
ri 1) L W
Property Tax ID #: 'rim 6( JA f, E 515F-5 Lot No.�
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
�1CavGrl 10 STD rta �t�,r� I%L �o� ��•a'
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: 2 S�%d Sq. Ft. of First Floor: f
Cost of Construction: $ �d.GCJ� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name d%W11 FAN d i
Name:,/Girl/e/
Address:'?LW PAL W "L f1 1A)
Company:,4/, 44G/ A6& /1fAIJ Aze.
City: fe rl ipif� 2 State: ��-
Address: 34 3 I� ' Pr) SW
Zip Code: 2N 44`) Fax:
City: \) em % &? - State: fL
Phone No. t-0), a-Il- 13`1 S
Zip Code: W6.1 Fax:
E-Mail:
Phone No 11%0g- a177-1T 7 g
Fill in fee simple Title Holder on next page (if different
E-Mail ,' '7a d . G61✓►
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: i Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 ublic records of St.
Lucie Cou ty ark¢ pos d t e jobsite before the first inspection. If yg�nten o a' financing, consult
with lender o:a n ore commencing work or recordiDe vodr�N m encement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA `
STATE OF FLORIDA f
COUNTY OF ,��.L1;1 i°.�I
COUNTY OF
Sworn to (or affirmed) and sub ribed before me of
✓
Swop 'to (or affirmed) and subscribed before me of
✓ Notarization
,P $ysical Presence or Online Notarization
day U_IA.\O by
P ysical Prese ce or Online
this day 202p by
this _14 of .2024
of
Name of person making statement.
Name of person making statement.
/
✓
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden"cation
Type of Identif . n
Produce
Produced
(Signatur f otar r Public- State of Florida)
(Signature of �_
a
arv� KAREN S. NIEL �y'
Commiss e2 a-''- a-Notar�Alic
Commission N
d'd'KAREN S, NI LSEI�f
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- a ission # id�7ai <:
Commission # GG 207484
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12, 2022
REVIE
PERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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