HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 71-741 Permit Number:
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o r
c EJ Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2.900 Virginia Avenue, Fort Pierce FL 24992
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: l ,`C� l I -� _ -J /
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 3 L1 1 (1 -0--0 > Lot No. 21-/
Site Plan Name:
Project Name:
Block No. J
DETAILED DESCRIPTION OF WORK: I
�3w l� n�,ow s�2e�► t�c�(( �,�c��z �(o�, p 2aa-4-�
x 4a''
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Gas Piping
Sprinklers
Shutters
(Affidavit required)
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ / SDI Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name N o- P-q d vi r� L. I as c4
Name: Yti'�c�-I l Q u� V1c�i2�c
Address: G 5O. 141 e. Xnw a 'c�_ •^-
Company: cf cz t� ("d Et S� �� 1-rr,"U .. i
oq j2
City: P4 P ; e a. Q State:1
Zip Code: _`3z14 Fax:
Phone No. L 477
Address: !Fi.3 tJ-�els 12cl
City: P, B 2 u State: /=
Zip Code: 4/ C/Fax:
Phone No ;�GUO
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 2 12 J n e & Ne'4/'I) C 0
State or County License '�Z/S!1 G
If value of construction is 2500 or more, a KtLUKUtU IVOUCC ui ..Mw — -
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S7 LuctE-
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this TI"- day of .TW LX 202.1 by
MAT TI4 E W M IkK V_X
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
TH HOLMAN
Commission No. 6 4-" 9-736y:3 (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev5T20721 _-
*Expires
RUNOTARY PUBLIC
STATE OF FLORIDA
Comm# GG973640
it 3/2612024
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW