HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
>J Building pp 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:ca
I PROPOSED IMPROVEMENT LOCATION: ri I
Address: I rt ( Q =Zt\-P (, nkjk -k .V--C) k - "- \ ,(-' 0 O `-f `-/ `l i
Property Tax ID #: I `A I y , O — CCpdLot No. P
Site Plan Name: \, -Q-- ; Nx\- ✓ N, Block No. II
Project Name Cl�, -\, i
FaI wad L, iFJ FL tSX( 3U,5 DUCE Sk
Cowt�e.r-,rK-> T- ji-,e c C qNS bIFFuSv5; -s 4rJo 62ILL r
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Addition work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C T t
Name:
Address: Cq-
Company: e (.%f' f`' - —c- ar) { ►- f l
City: } 12 State: _
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-
Address: �� I ) SW; h 1 �(' eyC�o f2ky°
City: ac' j j"6 L IC 4-2 State: R
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Zip Code: `7 `7 Fax:
Phone No. I—ql
Zip Code: Fax: 5 ,O i
Phone No
E-Mail: Dh-0,5 iU C3'mo I. Ccrn
Fill in fee simple Title Holder on ext page ( if different
E-Mail t i iP7 Cfi
State or County License( ,w " 1 LLIn2j
from the Owner listed above)
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 MORTGAGE COMPANY:
Name:
Address: Name:
City: Address:
State: City:
Zip: Phone Zip: — Phone:
FEE SIMPLE TITLE HOLDER:
Name: Not Applicable BONDING COMPANY:
Address: Name:
City: Address:
Zip: City: —. Phone:
Zip: Phone:
k Not Applicable
State:
Not Applicable
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 1 lict 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.
Signature wrier/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sr Vvc Lf_::'
Sworn to (or affirmed) and subscribed before me of
this 111 day of S��K k Physical Presence or Online Notarization
— , 20 Z(by
K.
Name of person making statement.
Personally Known -_ OR Produced Identification
Type of Identification Produced
(Sign
NIn4•�r.. D..L.I:.. c�_�_
I - ---• — c v nurlud I
Commission No. G blka(o4rS (Seal)
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REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
%Yr,;;;•,, KONNI LENAE DEWITT
{i•+i, •.
•• n `",� �=: Notary Public — State of Florida
ro •!�! ; Commission it GG 166915
IOIiM1 • , : my Comm. Expires Dec 10, 2021
Bonded through National Notary Assn.
SUPERVISOR PLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW REVIEW
MANGROVE
REVIEW