HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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�, -=w Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 1z
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: 1 q
Address: z /� Cb4�c �.1.�, ✓�� iTc�
Property Tax ID #: 11 CI 1-- (o 0-7 cx>a � �-- (60 _ � Lot No.�-7�
Site Plan Name: �� ,- Block No. 13
Project Name: lD,'Y_(2-! ``Ty�- S c
DETAILED DESCRIPTION OF WORK:
�; _ r i
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1 - Sq. Ft. of First Floor. aU
Cost of Construction: $ TUtilities: _ Sewer Septic Building Height: N
OWNER/LESSEE:
CONTRACTOR:
Name cL' 'CC c)e
Address: iA C.
City: ir rc-C, State:Vl--
Zip Code: C_� I Fax: N
Phone No.
Name:
Company:
Address: �_l 1 -1 S "M i ( � S �`
City: 1�/i� V,e,' State: GIL?
Zip Code: � -L ) Fax:
Phone No LA o-1 - DVQ ° 344
E-Mail: t0+e_c � u�( um-
Fill in fee simple Title Holder on next age ( if different
from the Owner listed above)
E-Mail 5 Z d _ P-C Y M 1 ,
State or County License C)60S
If value of construction is Z500 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 CONSTRUCTION LIEN LAW INFORMATION: Z
DESIGNER/ENGINEER: _ Not Applicable
Name: 'Q- l C V\Ckf d V� 'A S
Address: 1`1'l"1 S• i-Ia.YYiSiJ A
City: v State: C�0
Zip: Q LLD Phone - 2 2.7-
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
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 ur property. A Notice of Commencement must be recorded in the public records of St.
L ie ounty an po ted on the jobsite before the first inspection. If you intend to obtain financing, consult
with le der or a att rney before commencing work or recor ing your Notice of Commencement.
Signature of Owner/ L 'see/Contractor as Agent for Owner
Signatur o Con rac r/License Holder
STATE OF FLORIDA
COUNTY OF � LLk c--COUNTYOF
STATE OF FLORIDA
oynAL
Sworn to (or affirmed) and subscribed before me of
Swoo (or affirmed) and subscribed before me of
Physical Presence or Online Notarization'
--Physical Prese nce or Online Notarization
this 7� day of 2021 by
this � day of 202t by
TOM Si u gm
Name of person making statement.
- N
Name of person making stateme t. U Q N o
_
�JOM
Personally Known OR Produced Identificati�
a)mOM
Personally Known OR Produced Identificat�r� rn
Type of Identificati
m LL p
Type of Identification m }0 0 M
Produced 1`��, �
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Produced
ti O Q
UZWUU1
V O&AAA �Uli
(Signature of Notary P !c- State of I rida)
,�° 8
(Signature of Notary Pub tate of o da)
Commission No. (Seal)
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Commission No. (Seal) s,
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