HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 II Permit Number:
NJVo�J'CU,�
�0 �µ
P ° Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential -'-
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: ) l�O 1 Lot No.
Site Plan Name: Block No.
Project Name: �'. I a on �
►�
6�ETAILE'ID
DESCRIPTIONOF •'
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Name c CAJi 0� SC-6
Address:S' Q o Lcfys(xvu Pu`o wl
Name: `v `I C,
Companyl:'
Address: `1 S
City: T-FpSC-Cp State
Zip Code: S Fax:
Phone No. G'
City: 71--f—Rr1j39, State:
Zip Code: NG9 I Fax:
Phone No
E-Mail
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value or construction is csuu or more, a KtGUKUPW 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 joc)44te before the first inspection. If you intend to obtain financing, consult
with lender or an att me befo6Ammencing work or recording our Notice of Commencement.
� �' Y14;;?"
-�oA
Signature of Owner/ Le e/Co (actor as Agent for Owner
STATE OF FLO
COUNTY OF A ' C-,U-
!n
SworIn ^t�o (or affir ed) and subscribed before me of Physical Presence or Online Notarization
Al20,b
this �' day of by
--k�( y Cu Q tVcL)(1LDL V-)
Name of person making statement.
Personally Known I -/ OR Produced Identification
pe�o�f IdentificationProduced.
(Signature of Notary Public- fate of Florida )
tS�► DANIELLE GONCALVES �?
Commission No. (Seal) ` MY COMMISSION # GG 232946
• o`: EXPIRES: June 27, 2022
Boded itw Notary Pudic Underwrite:' _.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21