HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % / oZ/ — Permit Number:
L,. L LF
I;'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: ,E/ec14-,-c
PROPOSED IMPROVEMENT LOCATI011\11:
Property Tax ID #: 3C,Ga�-"5'96- O 007 ` OaO _ 6
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILEDDESCRIPTIONOF WORK: -- ----
f��f�lo ce 4,-,? 4 GYM
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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: Q
Cost of Construction: $ l ��
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
_ Roof Pitch
Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name p/� S� L tGL,C LLG
Name: Je 912, 'S o �!
Z
Address: �;?e— e zIvD
Company: A"C"WA bR
^
City: 7,0Sf L� � Stater_
Zip Code: 3gfS—Z Fax:
Phone No. 1S4— `F11S' 03 -7g
Address: /,9v/ -D S", fe
City: f'er State :t"�
Zip Code: ?2� b� Fax:
Phone No °gs (F— C,O/ r —S3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail /V"'c40/a-3 - #0a 4? cam,
State or County License �`f2 gooEf .
vcwc vi winatmmvn is c3vv or more, a Kt4VKutu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
'Ili 1411
-RA 10
�'�v,
�,< Ni,'•
Vie, i', 1'
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: D5 Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: XNot Applicable
BONDING COMPANY: D�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 attorney before commencing work or recording our Notice of Commencement.
I
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA Mlnoo
COUNTY OF �a NICHOIA State of Florida
.0 6�r/
°u,#e%.•: Notary Public # Gr 922464
Commiss,on•re5 Oct 22, 2023
Sworn Phsica
to (or affirmed) anA subscribed before me of orlry Commt t> jvlmtoi
this _ day of 20 ZL by 9�0fgondedthrough aid
Name of person making statement.
Personally Known -'----
OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- Sta S MiTTOO
NICHOL rate of Florida
Commission No. '��� PiQ� '•; Notary P 'c I GG 922464
2023
a COMM Oct 22,
Comm. ExP Assn,
•-., of �: h National NotacY
Bondedthroug
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev .5/20121