HomeMy WebLinkAboutWilder Building AppBuilding Permit Application
Building and Code Regulation Division Commercia I R d t
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: /_LI'/. _L
All APPLICABLE 1 O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �1 Permit Number:
�� .,r nY�
C L '� L+�.
Planning and Development Services
C;J en Ia
T _ Lot No.
Site Plan Name: ko� 1 ' ac if)(.. Block No.
Project Name: Ab"'Na' mf x�c .
I DETAILED DESCRIPTION OF WORK:
5
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: SO Sq. Ft. of First Floor: �)
Cost of Construction: $ S1 I Z(o?) o Utilities: —Sewer 1.ySeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name E\6, = ('
Address: �� �u ���alnl��a.
City: rory a, t''r%C: Stater
Zip Code: _�'A)GI Q Fax: �� �,3`13" r�`%I 14
Phone No. - �5_ ``'
Name: C
Company: Caf nlga .AiY'erc'
Address: O _7_)(0
City: S-)Vb,.M4Z,, Stater
Zip Code: Fax:
E-Mail: '' "M "i(1 1 44->LlI e
ThoneNo WA- II110
Fill in fee simple pile Holder on next page ( if different
from the Owner listed above)
E-Mail` 'a �� ' I
State or County License . I Z 15 f
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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an-attornev bef4ire commencing work or recording vour Notice of Commencement.
�
Signature -of Owner/ ssee ontractor as Agent for Owner
Signature ntractor/License Holder
STATE OF FLORIDA r
COUNTY OF �; "_�
STATE OF FLORIDA Q
;`' iii.v
COUNTY OF
Swann to (or affirmed) and subscribed before me of
Sw n to (or affirmed) and subscribed before me of
il,' Physical Presence or Online Notarization
Physical Presence or Online Notarization
this � day of der) h y 2024 by
this day of GJ U- W_ 2020 by
G
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PL• yr
�.
_ �-
Name of person making statement.
Name o person making statement.
G
J4
Personally Known OR Produced Identification
Type of Identification
Personally Known OR Produced Identification
Type of Identification
Produced]
Prod ced
y^F XLI_1�1
(Signature of Notary - to R§ftPRy�iq State of Florida
(Signature of Noa
Katte n l
• My com�Tiissi�n HH 006821
Comm' Issiorn ,No Expires OaAN 024
URGIN
Commission No. # t 49
ust 25, 2023
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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