HomeMy WebLinkAboutBldg Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�g1r. 1�5ucUL F
ff11 E Pn 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: n�1
A -IV cohJi4fo�llwy / e�iQttge' UVt
PROPOSED IMPROVEMENT, LOCATION:
Address: 5-40 5Iev IiN Latke D , (Drt Rev-ce F- 34q 51
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
-,g
10 IL-W
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 -Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
v
Cost of Construction: $ 4 1 5uo Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR: "
Name TUlnM klrome. J-e,otoria
Name: hq�') VrJ iyie5o
Address:'7T4(0 c14Zr44 )-A(Zp T);r
Company: —AU% it t?yvU�i�lt7h�xq Coin
City: 12) pie-c J Stater
Zip Code: -3 Fax:
Phone No. 4— 614-1263
Address: 66g5 NW 40flA 5`�sC'er
City: Virg vkia t kYJ n9 state:
ZIP Code: 33I(9& Fax:
Phone No M-AW-),;Qp
E-Mail:--Ieu4L.GGiol, 60m
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mai1,P AC )6yier Sal .l iovo J w!ci11, Go
_
State or County License CAC 1$1 7
•._.•,.....u•• ,_ &, ur more, a nca unveu nonce or commencement is requires.
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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V Not Applicable I BONDING COMPANY:
Name: Name:
Address:Address:
City: City:,
Zip: Phone: Zip:
V 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 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'AN
otice of Commencement must be recorded in the public records of St,
Lucie County a sted obsite before the first inspection. If you intend to obtain financing, consult
with lender o at or
commencine work or recording vour Notice of CommpncPmPnt_
Sign&6 re of 0 actor as Agent for Owner
naturdof Contracto��se H to der
Wess/Co
STATE OF FL O
STATE OF FLORIDQ
COUNTY OF
�
COUNTY OF IV\ I G\WlI _,)
Sworn to (or affirmed) and subscribed before me of
Swos to (or affirmed) and subscribed before me of
)� Physical Prese a or _ Online Notarization
this 4.!Itday of e6 by�
✓ Physical Presence or Online Notarization
,22
this _�L day of 2024 by
IC�b T-L�'g/d
ha VG ldiyiem
Name of person making statement.
Name e person making statement.
/
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identification
Produced
Type of Identifi tlon DL_.
Produced
(Signature f Notary Public -Slat of fPI dda otary P�buo s,a,e or Fiona
lizabefh
(Si a re of o ary Public- State of FI
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Co mission No. 1 �T�I �Z�I�
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
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