HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
s``Lo LILU uLd
QQ U1 ,
E ° � `mot 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:
Address: 12 `qq5 ��a r !"lQce-, lr;er�� �—c�• .� 98/
Property Tax ID #: �ZZ c% �Ja Lot No.
Site Plan Name: �L di9v/� Block No.
Project Name: r/ �✓`Af�SmJ �J[/�d�
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
(Affidavit required)
CONSTRUCTION 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
Total Sq. Ft of Construction: /yam i00 Sq. Ft. of First Floor:
Cost of Construction: $ 7R D Utilities: _Sewer v Septic Building Height: /0,75"
OWNER/LESSEE:
CONTRACTOR:
Name /• A( DSO
Name:
Address: , ex- /44
Company:,B K19�-'.�Y
City: Phi en-e State: 6-
Zip Code: .3ggf l Fax:
Phone No. 774 -.S`P_ 8 - Cg22-
Address• 30fo kJyh,',f PWv rf • �� �
City: Sa4414-fi'W State:
Zip Code: 3 Z91/ Fax:
Phone Nolei~�lta- - ?_1-332-207c,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail "` H/-A L-&Al; R 64, &
State or County License
If value of construction is 2500 or more, a RECURUEU Notice oT Lommencemeni is requireu.
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: ✓ Not Applicable
Name: 111a rvi,1 C&Idyef/
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 our Notice of Commencement.
/41� a)'111�
Signature Owner/ Lessle/Contractor gent for Owner
STATE OF FLORIDA�
COUNTY OF
Sworn to (or affirmed nd subscribed before me of ZPhysical Presence or Online Notarization
this -7 day of 20& by
Name of person making statement.
Personally Know OR Produced Identification
Type of71de,icati n Prkoduced
J�-c.%
(Signature of Notary Public- State of Florida )
,)jx Y� Notary Public State of Florida
Commission No. (Seal) _� `� Billie Falkner
my commission GG 246237
'v,F of tio� Expires 09108/2022
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21