HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `4& /° / Permit Number:
7711,
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: E
I _e C_ r, C'
PROPOSED IMPROVEMENT LOCATION:
Address: Ckp& / 9 / r o c k JA"t " -�4_ /2
Property Tax ID #: �•�� `Sb / - U OJ, - o o o , o
Site Plan Name:
Project Name:
Lot No._
Block No.
I DETAILED DESCRIPTION OF WORK: I
L.-"J& 10c- cL 1. 2 _e "Vicy
00-q„i,2 o'1_r-tC-4/�-Y7a.-- Com.6o
New Electrical Meter Second Electrical Meter 1/` (Affidavit required)
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: Sq. Ft. of First Floor:
Cost of Construction: $ /-D D J Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
r.rz Uc�.z
Name: / CcK�'
Address: o7Lt?/g ��rroc����'-} �- 12c�•
Company: Sr cd I-fe- /C, bt C -
City: ". 0--e /c-C State: rZ-
Zip Code: yri,S/S� Fax:
Phone No.
Address:,_,'f-b / ZL) .
City: � �i'_,e -cx State:�L_
Zip Code: t1/1 V Fax:
S�`/-6
Phone No -7 "7a Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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E-Mail j, J-J' Ca.J'A'�63J- JW-eI-eC 4k-I
State or County License ,EC /J6 U
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 CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
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Name:
Name:
I
Address:
Address:
City: State:
j Zip: Phone
City: State:
I
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name: j
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 bylaws that
rules, or and covenants 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 your Notice of Commencement.
Signature of 0' mer essee/Contractor as Agent for Owner Signature of Cori actor/License Holder
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STATE OF FLORID k STATE OF FLORIDA
i COUNTY OFF . �.L,� , COUNTY OF.
Sworn to (or affirmed) and subscribed before me of Swop n to (or affirmed) and subscribed before me of
✓ Physical Prese ce or Online Notarization V Physical Prese e or Online Notarization
this day of u 2021 by , thi day of 2020 by
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Name of person making statement. I Name of person making statement.
i
Personally Known OR Produced Identification i Personally Known ✓ OR Produced Identification
Type of identification i Type of Identification
Produced Produced
( ignature of Notary Public- Sta „., ture of Notary Public- Stat o , 1, a
,
URA R CUBBEDGE <�" ' '' URA R. CUBBEDGE
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,, mission HH 013089 ' =�; Co fission HN 013089
Commission No. Com ission No.
o; x�ires Odo*21, 202z _ .>,F op� October21, 2024
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE i MANGROVE
COUNTER REVIEW ; REVIEW REVIEW REVIEW REVIEW REVIEW
i DATE
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I RECEIVED
! i
i DATE
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COMPLETED
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Rev. 5/6/20
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