HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
LUCLL .
l-
` ` 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:
J
Property Tax ID #: _ D1 3a(�, ,. y (j _p�(o- (]pp - Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter V Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank — Gas Piping Shutters
C Electric Plumbing _ Sprinklers Generator
Windows/Doors Pond
./ Roof Pitch
Total Sq. Ft of Construction: A) 9 S I Sq. Ft. of First Floor: I��q(D
Cost of Construction: $ Ad%7i 000 Utilities: —Sewer ✓Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name UN d ol\& �\K;�� .�,b�
Name: -A
Address: 3`i
Company: 1&rs
City: k efc State:
Zip Code: 3H `) S _Fax:
Phone No. S(9I -IS?
Address:
City: PS L State.T-L
Zip Code: 39 g5S Fax: _
Phone No "111 33b- _7US�>
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_
E-Mail ( u.i( A w•
State or County tAense ! SP.c( 7�N -
•• V0 — W UUII• LIUP6L U11 3 4JUU U1 111Urc, d—t-umucu rvonce or 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: Ckr15 4z e-r_S
MORTGAGE COMPANY: Not Applicable
Name:
Address: 51 09 6-CovNI P4„ - "L
Address:
City: State: L
Zip: 42-1l Phone 11 T- 418 - L-Aj3 S7—
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: o� 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.
411. ��4 1204,1,410
4Z a14 24;)
-
Signa tyre of Owner/ Less /Contra or as Agent for Owner
Si q0ture of Contractor/ ' ense HoldqV
STATE OF FLORID Q
STATE OF FLORIDA
COUNTY OF �- L1.tc 12_
`
COUNTY OF S'�-_�C-Ve
Sworn to (or affirmed) and subscribed before me of
�/ Physical Presence or Online Notarization
this 2_'T day of 2026 by
Sworn to (or affirmed) and subscribed before me of
\.,�hysical Presence or Online Notarization
this AI daffy of 202t by
o—
Name of person makin statement.
Name of person making tatement.
Personally Known OR Produced Identification
Personally Known '--- OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�
� ,
(Signature o ary Public- Sta Florida)
(Signature o otary Public- Vate of Florida )
Commission No. 1-i1-����5��0 freaLl _
k tN Flnby
Notary Publlc
� Finlay
ary Public
Commission No. �'i OAS a.5willState of Florida
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