HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
1�'�0
° p -`—' 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:
li
Address: i) 1 j� i \ LC_ .��;"� L �? l , it i 1-1 ��i �'. il' s'
Property Tax ID #: 0-� (C1 V r LTV I h1JZ Lot No. Ut 7
Site Plan Name: /+ Block No.
Project�IIJ P..
DETAILED DESCRIPTION OF WORK:
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:
Cost of Construction: $
_ Gas Piping _ Shutters _ Windows/Doors _ Pond
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �0 c'c1
Name: ciS4Ck
Company:
Address: 15-z>0 -i?v(-e _ e_ W
City: 1pr-� State:V—L-
ZipCode: 3yCJy,� Fax:
Phone No. 4t0 • of `7 -6 ' 31461
Address: //--_% L l i7 )t �, i 071"
City: 'h-a )TI9 [ �L
y: _� � l . c.� ���') State: �-'
Zi Code: -, j 5 L Z-/' `'J Fax:
p ,f C � l '
Phone No -ZO f 'e�') i ' 03 U/) ,
E-Mail: LC�IQ���Q�c`n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail E'�i1"1 t�/�O s��-z�
iTI- -1[[ f&
State or County License �.t11r
v t
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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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:_
Address:
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 Contractor/License Holder
Iignatu Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
STATE OF FLORIDA l
COUNTY OF i'c: ; I /1�1 P'G(,�
COUNTYOF ilk.-,
Sworn to (or affirmed) and subscribed before me of
Sworrp-to (or affirmed) and subscribed before me of
!Physical Presence or Online Notarization
Physical Presence or Online Notarization
this ;';; " day of ;"% 2024 by
this t; day of I i .L'; 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
i
(Signa re of Notar i4,•i�if$e_ of Florida JSAN SERNA
(Sig to of Not Public- ° •� :lo ,i lSAN
..: �v��y Public -State of Florida
?: 1. Notary Public -Stale of Florida
Commission No. ;;' s`, Coal s n ll HH 1J2714
- • �= Corarrission N HH 132714
Commission No. � oF�r�°°r My g6eialJxpiresMay 23, 2025
My Comm. Expires May 23, 2025
Bonded through National Notary Assn.
Bonded through National Notary Assn.
P.
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