HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 a Permit Number:
'M99upri Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ,/� n TT-yS-TAU(- -rl n,ti-2I�LI✓V�
----- ----- — — -
PROPOSED IMPROVEPv'Ir=iv' LDCAl ION: �tV
Address: D\Q3 0 kII ib hQLt 901-+ 1 W- LQJ'VL 3Y951
Property Tax ID #: ��i I u - 50 I ' \ WkD - LA CJD - I Lot No.
Site Plan Name:'�)V. U-L(lk 2C1 3(D 4AO B(1CZ 5 I(pS of LOT (o Block No. 2-
Project Name: I�\arfkn- 9--OtLt)
In sfti `/r icw� 12F a- 3�u 1 az LZJXLa c GfLAQ,ra.td)- 6:v177-7
a411 Q,G(t= 0 & . J rM/7 S%r t t�,hh / n S halUd t
Gi7,IldVAS and MC D/Gl/{'Pk&,PA ti Ooly
New Electrical Meter Second Electrical Meter
CONSTRUCTION'INFORMATION:
_ _ --
Additional work to be performed under this permit- check all that apply:
Mechanical _Gas Tank _Gas Pi ping _Shutters —Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
q
Cast of Construction: $ ! Utilities: -Sewer Septic Building Height:
i
OWNE -SSEE --Yi
CONTRACT OR: ---
Name , 4m (Un,Ib,A 1 i (J)& YTIJ-)
Name ii'IClGU F �ll�l ✓UY]
Address:606th P100,
Company: Til4 ill
City: P17Yf- S t• ty.,W 4 State:
Zip Code: ?j4c7 rii Fax:�� IU'5z%
Phone No. -77% - q701 '" q3r>8
-Ai'llrni
Address: -7cffj Sbv 1(k �I f17QS �{ I UQ
City: 5ii lPl et Stater_
Zip Code: ;3L7RG-;L Fax:-1%2 - 210 -5-92S
Phone No -7 7 - 1 U - C.P ( GTj
E-Mail: rise S 1 / Pbfo& -fh - %l:T
Fill in fee simple Title Holder on next page (if different
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E-Mail �rz O C t L( (L,C an e i V,Q
State or County License 60 1360 Lc J3 S'
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 CONSTRUC fiON LIEN LAW IM-ORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _ of 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 attoaW before commencing work or recording our Notice f Commencement.
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Signatute cif Owner/ Lessee/Contr ctor as Agent for Owner
Signature of Con ractor/license Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF IT) f7iLi1 n
COUNTY OF vh tB' =12 n
Sworn to (or affirmed) and subscribed before me of
✓Physical Presence Online
Sworn to (or affirmed) and subscribed before me of
or Notarization
this Ot day of ,I A !_� 2024 by ��
hysical Presence or Online Notarization
this g day of `J ,LI � _ V 202A by Xf_),1
I
M Crib itvv W'u e r orn
MCkMp N.,—"R au I e V,c on
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identificationy
Type of Identification
Type of Identification
Producedn rive n CP
Produced -DEQ l 1APWIS'-P
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( 1fAN\ illl•il. Y Y ' f JY/rf ��
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(Signature c& Notary Public- State o lorida )
(Signature of Nbfary Public- State of Flo a )
Commission No. �(J (Seal)
Commission No.C!5� _'5 Q 13 (Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
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