HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE'INFO MUST BE COMPLtAl) FOR APPLICATION TO BE.ACCEPTED
Date: Permit Number: 4105 -% $
Building Permit Application
Planning and Development.Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
J.
PROPOSED IMPROVEMENTLOCATION
Address: So S "Mon ik Lu64e. Ck f- L eu-c
Property Tax ID #:. Lot No.3
Site Plan Name: tlr I�a.r� 0,131 Q Co It '1023- 10 5 Block -No.
Project Name: i-�Aa%y- c_vAcv--e.V� (,a'C�y-eow��'iao� e�` e V_YLml b r+LG2�ca.(
DETAILED DESCRIPThON':OF WORK: ,
'rill vXto vi l e_v-kl & -Oho "V_ S 10 rGy �.
±ea:mi1 e- t-c'-ea-ime-1 ove,r Saud' • ill Ives 1oirP, C.oneVLt, 'to 1fy-e s
c,.i>yt, _ iyi c A wAi ti-s yA (r -0—b ca fr
New Electrical Meter �A Second Electrical Meter/y U s n� sa4rtWi sw v
C.ONSTRUCTIbN INFORMATION I
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
TotalSq. Ft of Construction: J�U r Sq. Ft. of First Floor: _
rVa Vz
Cost of Construction: $ cy Utilities: ewer §6teptic
Building Height:
i
OWNER/LESSEE ; :..
CONTRACTOR;
Name :10 0t�vi b
Address: W t
City:. F- State: f I-.
Zip Code: A 3 3l 1 Fax:
Phone No. o1S" LA ' , 3 U - S 8-c(1
E-Mail: bcutemast' c. CoMe.as-t, h eA
a.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: s
Company:
Address:
City: State:
Zip Code: Fax:
Phone. No
E-Mail
State or County License
L
If valueof construction is 2500or more; a RECORDED Notice of Commencement is:required.
If value of HAVC is $7,500-or: more, a RECORDED Notice of Commencement is required:
J.SURPLEMENTAL CONSTRUCTION 115NIAW INFORMATI.ON-
Name•
Address:
City: State:
Zip:1 Phone
FEE SIMPLE TITLE- HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not'Applicable
Name:
.Address: i
City: State:,
Zip: Phone: 1
BONDING COMPANY:
Appli
Name:
Address:
City: j
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. i.
St: Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structu�e
Which is in conflict with an Y 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 attornev.before commencine work or recordine your Notice.of Commencement..
SI ature of Owner/ Lessee/Contractor. as Agent for Owner
Signature of Contractor/License Holder
STATE OF-FLORIDA
STATE OF FLORIDA
COUNTY
COUNTY OF
-OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before.me of
X Physical Presence or Online Notarization.
Physical Presence or. Online Notarization
this day of LAai , 2024 by
this day of. 2020 :by. !
:Name of person:making statement:.
Name of person making statement.. I
Personally Known OR. Produced Identification
Personally Known OR. Produced Identification
Type of'IdentificatiQn
Produced ��-Lcsl�ob �%115 ��Cc/��C
Type of. Identification
Produced
I
(Signature of. Notary Public- St
Ignature of Notary Public -State of Florida) I .
���� /p1 �� �7 � r f=: ADAM POMALES
Commission No. VlV� lv�a3( ^�ISkM(jy?ublie -State of Flori
mmission No. (Seal)
Commission N GG 206318:
a
My Comm. Expires Apr 11, 20
2
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Rev. 5/6/20