HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L' L 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: /I1 v.cr l-3 /1 All
PROPOSED IMPROVEMENT LOCATION: .t/ {�i6J� �� y A!/,1 i!Z-
Address: //1?99 tl Ail /6/fL-- c 41-14 -1-//z
Property Tax ID #: //-/ / 41 — &LO72- , Oo V Oo4 - O Lot No. Vui //Z
Site Plan Name:
Project Name: `/ N /-t/ 0/-/ t—'A`/ 10-// -2-
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Block No.
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ZZo O
Cost of Construction: $ �;?- HD O
Sq. Ft. of First Floor: / dV 0
Utilities: _Sewer _Septic Building Height: '7e9lr`�
OWNER/LESSEE:
CONTRACTOR:
Name TNlet:- r�4 14 SL//Yff
Name:
Address: H�/N� NfF/a�/y H*/g�/� *//Z-
Company: /%LNWYi6�m
City: -t:31.0� ,r/ State: ,E-/
Zip Code: 'l U %4/q Fax:
Phone No.
Address: 3573 ,vw 917-XWI�-tH=�S Z-^�
City: /%.w N%-Z
Zip Code: 3 V !EX eg T>
Phone No '772- l Z'/
State: G�
Fax:
9//49
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Co G}v/L Oe*
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State or County License GAG
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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.
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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.
1 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
wit nder or an attorneybefore commencingwork or recordingour Notice of Commencement.
Signature of Owner/ essee/Contracto s Agent for Owner
STATE OF FLORIDA��..,`` uCOUNTY OF�3�— C�2.
Sworn o or affirme and subscribed before me ofZPhysical Presence or Online Notarization
( )
this o2 day of 2��, by
A111" rnid-C.)
Name of person making statement. /
Personally Known R Produced Identification V
Type dentificatio Pro ced PL
(Si a ure of Notary Pub - State of Florida )
//►► Jason Hendry
C m scion No.i *6_(Seal) ,�� ColrMtlssi0nIIB
Expires: Febroary 23, 2023
��. Bonded Thal Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev5/20/21