HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datei'7CAr1�r iTPermit Number:
�I "(I'll -"4:1
0
F "ns"'r a a Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:. _ , '
PROPOSED IMPROVEMENT LOCATION:
Address: i :Y�
y _ t Lot No. .� 1
Property Tax ID # - I - -
44
p f Block No.^
Site Plan Name:
Project Name: `
DETAILED DESCRIPTION OF WORK: C HeoAf
New Electrical Meter X Second Electrical Meter
CONSTRUCTION INFORMATION:
Add itionai work to be performed under this permit- check all that apply:
Mechanical
Electric
Gas Tank
I Plumbing
Gas Piping
_ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors ! Pond
Roof Pitch
Utilities: _ Sewer — Septic
Name ►+ U `
Address: I 'r
C� � l State: �L
City:
Zip Code: —Fax:
Phone No. _'11 2
E-Mail:. S �(a�1�1� C ►�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:
Building Height:
Addre :GAuS iVt.� L.r ch
City:-. c State: EL
Zip Code: Fax:-�1-2OOb'-
Phone No
E-Mail3 G l' r. L—_
State or County Licenseyr•, i "
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
if value of H"C 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:
Not Applicable
BONDING COMPANY:
_LNot Applicable
Name:
Name:
---
Address:
Address:
City:
City:
Zip' Phone
Zip: Phone:
t
a
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit o ao tine wur R iiu,"�.a
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
structurin e, Please consult with pyour applicable
ome Owners Associat on iandrreview your deed for any restrictions which may aprohibit such
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 SRmmencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF uCOUNTY OF
Swo n to (or affirmed) and subscribed before me of
Physical Presence or online Notarization
this day of 202q by
K n T; Q f 6 '1 —
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
( a r of Notary Pu ic- State of Florida )
&W JIJUE JANE MCCAULEY (Seal)
Co laida
Commission ! NH 44824
..OF .. AMr Comm. FunIn s net 1 7A ,
I -
Ann.
REVIEWS
G
REVIEW
SUPERVI
REVIE
FkO-N I
COUNTER
DATE
RECEIVED
-
DATE
COMPLETED
ev. 672
Sworn to (or affirmed) and subscribed before me of
'� Physical Presence or Online Notarization
this day of 2021 by
Name of person making statement.
m
Personally Known V OR Produced Identification
Type of Identification
Produced
,., r„rP�,f�intar�r Ruhlic�.5 �o�F�r1GIa )
JULIE JANE MCCAULEY
Notary Public • 5tatr of Florida (Seal)
ommission H 49824
my Comm. Expires Oct 1, 2024
WOR I REV EW rP
VREV EWON S REVIEW LE M EV EWVE