HomeMy WebLinkAboutPermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:? ,� I ,�-�— Permit Number:
U�o LulEL -'
G `A C L
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Residential
Address: �/ '—jyjari h , oer.
Property Tax ID #: 19 0 ( - of -- C)OO ` Lot No.
Site Plan Name: fl fQ i cat O Ck r ,S-e cli on Cane, Block No.
Project Name: f,,ik (—'CJU t CI
J DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit— check all that apply:
iGlechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ �3
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: -L
Address:)f�i !� -,
Company:
City: I` i 0 rCA(I° State: j!_L1
Zip Code: Fax:
�,
Phone No._�'`3�®-�
Address: E
City:bccrE 00 j CI,-\
Zip Code:. ' L4�
Phone No i-
Fax:
r0i 2 /,r
tate:Fi
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E-Mail: !? ' ••• �� i
Fill in fee si le Title Holder on next page ( if different
from the Owner listed above)
t
E-Mail & 1�s20og qq
CACi
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State or County Licensee IQ+►L ()
.UULU u1 wmmencemem: 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
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 such
prohibit
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.
Signatu r Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF- h
Sworn t„Q (or affirmed) end subscribed before me of Physical Presence or Online Notarization
this day '
of � 20— by
Name of pe,son snaking statement. a
Personally Known OR Produced Identification
Type of Identification Produced
Signat re of Notary Public- State of Florida )
Commission No. -21 14 Marissa C. Gomez
Comm.#HH031824
Aug.13, 2024
TM AM Nota
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
VEGETATION
SEATURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 512012-1