HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L�rl�11�
r ° ° � " - 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:
PROPOSED IMPROVEMENT LOCATION:'
Address: 197 1--' Aee7-Ai e r i
Property Tax IDIt: 7PN&73 �oy O%6 OOo 9 Lot No.
Site Plan Name: Block No.
Project Name:
L DETAILED DESCRIPTION OF WORK: -
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New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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 G 3 O Sq. Ft. of First Floor: Z6 7i
Cost of Construction: $ /0o o <-1 Utilities: —Sewer _Septic Building Height: /457 FT
OWNE%ESSEE; ..Name:
CONTRACTOR;
Name =/L/�17✓ 7c 2_
Address: svm/ 91--174 /¢,ice
Company: /!2y AZ 0--IIDOAe, �LLL
City: 'i"7-r 1/ ,CN e-F' State: A/
Zip Code: 3 / 9 0Z Fax:
Phone No.
Address:3g3 G,x--'
City: liO�4f-.Z c.c ey Stater/
Zip Code: l C/ c�F rS 3 Fax:
Phone No 7% Z ZLK 4� // r�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 69 r3 uiL-PpzS /S-ro 6-l2e'99L. 4-a-t -
State or County License GGG 132, 0 7 3 Z
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.
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 attoxnev before commencing work or recordine vour Notice of Commencement.
Signature of OwnerfLessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to or affirm and subscribed before me of ZPhysical Pr en N i
( e aPresence or Online Notarization
this day of 202ik by
Narhe of person making statement. /
Personally Known R Produ d Identification v
Type of Identification Produ ed
(Signa 5ionN
otary Public- to of Flo a )
Commis. (Seal) �,��,�'��, Jason Hendry
Comrnbft # Gt33000fl6
Expires: February 23, 2023
�>>,,,� ai` ' ����•�`' Bonded Thru Aaron Notary
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED