HomeMy WebLinkAboutSLC PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
1�v b aps `
0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: 3 Lot No. 7
Site Plan Name:
Project Name: ALATff�
I DETAILED DESCRIPTION OF WORK:
M,,r 1 C,k
pie 1 _:� _ l I L_ 1�. ► �! p I
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:
Cost of Construction: $ 3/ 94e), cap
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name If
Name: z-
—U&A4&_
Address: 2a1, G'0tA_ ";0g zy"iA__I—
Company: '07 A5�/-t.
City: State;
Zip Code: 21Y �15A Fax:
Phone No.
Address: a.?Y
City: 0� 1.9.ii� _ Stater
Zip Code: Fax: 4114
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: I
DESIGNER/ENGINEER: Not Applicable
Name:
A��r live —
Address: z
City: _ 'E State:
Zip: Phone �• - �6'
FEE SIMPLE TITLE HOLDER: V Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: V 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, wails, 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 commencing work or recordine vour Notice of Commencement.
T � �
Signafure of Owner/ e�see/Contractor as Agent for Owner Sign ture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF %j?0WAJ COUNTY OF1Zt741 T
Swop�to (or affirmed) and subscribed before me of
V' Physical Presence or Online Notarization
this day of 202.$ by
Name of person making statement.
Personally Known k""_ OR Produced Identification
Type of identification
Produced
(Signature of Notary Pub -
DEONE mu -U4C
Commission No. YCOMMf8Sl 285220
2022
E�(PIRES: December 18,
�•e Publi ullldefwriiers
O � Rnn/SAI� T1�tu $IOYsr}' __.v.. ��mH�
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Swor to (or affirmed) and subscribed before me of
Ph sical Presen e or Online Notarization
this _2 day of 202J( by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Sigrfature of Notarv_P _ --
� .�--._ D£C)NE mU[CK
Commission No. _r....... "_ MYCOMMISS f gc''285220
EXPIRES: December 18, 2i]22
n:_.,,,,,�ThnihlntaTvPublicli;adeswrilefs
SUPERVISOR PLANS I VEGETATION I SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW