HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -1° 1 5 -Z 1
Permit Number:
�a 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:
C
Address: E-5q n V i cc ! Qy f7+ R)CE CC F71 _34C(Y2
Property Tax ID #: 3402 - ON - 05 2 " WO-7 Lot No. 2 14 ZZ
Site Plan Name: iCin over Psto+cs 'l nif 61 61Y- tot Lb-) -s 2-1 d 22 Block No. LO-2
Project Name:
:moo cc_ q -i C-,Orate C� c e
CI
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit —check all that apply -
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Gas Piping
_ Sprinklers
Cost of Construction: $ ► �FJ. o�
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
Name CQ Styr1 Cnl'1Skac7hUrr-�
Address: PC) 1 Z14-
City: P- P) c r c-r-- State: El
Zip Code: •3L CQ-1CA Fax:
Phone No. -1-17 • 5-1C1 - Ci323
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Connie- C-irntCc-
Company: $ bC-gnjC]QQL C-1CX7r ,
Address:_ 35 K.kQ enAL-06 S-(f:, Dl'
City: %Y+ S� U)'C'i-c— State: rI
Zip Code: 34-Cl"gLo Fax: ` -17 -y-Is%0•-1103_r7,
Phone No --f-12 y-to0 —1U30
E-Mai 17f�;1 SAP L 1�S�C,Care�teClmrS S� Co m
State or County License 3trJ�)
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
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 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.
Signature of Owner/ Lessee Contractor as Agent for Owner
STATE OF FLORID..
FLORID_..
�k/ci C
COUNTY OF
VPhysical
Sworn to (or affirmed) and subscribed before me of
Presence or Online Notarization
this 2--' day of J-J 1�1 20'2-1 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Publi - State of Florida )
•"W PL"'
Commission No. (Seal) �1
MICHAEL WALZAK
Commission M HH
E,,Pir*s February 2, 2125
Ba ,.,a Tlru Si*et No" S�rYbN
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21