HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CQ Permit Number:
^' �^ `? 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:
PRC1P Q°IMPROVEMENT LOCATION.
Address:
y 10
Property Tax ID #: s]�_1_ .) U ►! -?� Q DU_ �.____ Lot No..
Site Plan Name: Block No.
�1
Project Name: ,�Q i 1 i F1(Ck--
DETAILEa DESCRIPTION OF WORK:
%1 .. 1 n A A ✓% i, n .n J_ .......... - - Llr, �I Lt y/-✓ /� (` 1 n/l� n rli ► . _ .. . .
New Electrical Meter
-T s_ _ e 02 - 9-i�w -- - _ -
Second Electrical Meter
Additional work to be performed under this permit - check all that apply: io
Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric — Plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction:
Cost of Construction: $ E3 ( l
Sq. Ft. of First Floor:
Utilities
Name_t_—_LLA 1 f 1(-, r lI
Address:V
City: eave. - --- - - - State: -
Zip Code: Fax:
Phone No. R L • 18 1Q0_— _
E-Mail: r eQ
Fill in fee simple Title Holckir,on next page ( if different
from the Owner listed above)
Windows/Doors _ Pond
Roof Pitch
Sewer _ Septic Building Height:
CONTRACTOR:
Name:7�d:(���.-1_ ( C _
Company: Way)
)
_ ( 1/ { iloal III
Address:_1
City:r��n��77Q�'�__ State: rnn�
Zip Code: 32(. ----Fax: ._q"1.___Q� (l
ft one No_
li-- l�-"L. �J-- - - — ---- - ---
E-Mail
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.
UPS?. M,ENTAl',,CQNSTRUCTI0N
-
LIEN LAW INI"URMATION-
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 lendpMr an attorney before commencing work or recording yor Notice of Commencement.
Sidr ature ®fawner/ Lessee/Contractor as Agent for Owner
STATE FLQRID � �1 UCOUNSTATETY
COUNTYY OF
affirmed) and subscribed before me of
31 Pres�nceo�rp—Online Notarization
y of _J_�J 1,1L , 2021 by
Name of p rson makings atement.
Personally Known OR Produced Identification
Type of Id ratification
Pr uced
ctor/License Holder
DA
Sworn or affirmed) and subscribed before me of
Z��'�P sical Pr ence or _ Online Notarization
this day of�___�- 202t by
Noa h wool
Name of person making statement.
Personally Known OR Produced Identification _
Type of Identification
Produced
�� tiANDA J. HUMPHREY() AV AMANDA J. HUMPHREY
Y P� �kn-state of
k-State of Florida ,,��,V,��,,, C11
(Signatur Nota � - rztecvf hit)4&%n) Tres (Signatu otary Pu T, E_ � I(}fifi4ixiission # GG 938803
�: N;y Commission E>.pi s�
'3'►a.�a;�' AP it t0, 202A :Ac My commil0, 2024pires
Commission No. """`�� Commission No.
REVIEW FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER i REV
IEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVE
DATE
COMPLETED