HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : 1 I Z Permit Number:
° 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 : F I
PROPOSED IMPROVEMENT LOCATION :
Address :
Property Tax ID #: j LS - lr 3 - C- Lot No,
Site Plan Name : Block No.
Project Name :
DETAILED DESCRIPTION OF WORK :
L{ 'CTC L( o3 o SLk . .30 OvL) 61L' .
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION : 1
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 : $ �� � Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE : CONTRACTOR :
Name � > [ c� °moo bPu �� w �c � . 1 [x J� Name : V _
Address: Qo box ( Qg3M a� Company: Htom ( �rnndr� � o✓t�� �
City: \ ) C'Vvo 0�CO c.k' . Stater- Address : lci I �p l ri� M6Luru A .
Zip Code : 3 2- l c e 4 Fax: City: 0k ten LO au State:
Phone No. Zip Code: 3 16 Le Fax: 1 a 2 53 Uo
E-Mail : Phone No—'I ') a Z 1. co3
Fill in fee simple Title Holder on next page ( if different E-Mail k yjvekc4 ld � i V 0. C (a) yfko0.
from the Owner listed above) State or County License LW , 0S l ,C1 .
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 :
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: VNot Applicable
Name : Name :
Address : Address :
City : State : City: State :
Zip: Phone Zip : Phone :
FEE SIMPLE TITLE HOLDER : VNot 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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is In co 1 lct 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 pp6perty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and on the j ite before the first inspection . If you intend to obtain financing, consult
with lender or a me bef commencing work or recordIn our Notice of Commencement.
Signature St Owner/ Lessee/ actor as Agent for Owner
STATE OF FLORIDA
COUNTY OF iL [AXE OLn y-
Sworn to (or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
this ),�I_ dayof . ALL 20,9A by
N%�� NL \AAv4 �S
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificati n Produced
(Signa drepf Notary Public- StNte�of Florida )
Commi on No. (Seal) " )ENNIFERGINADOWMCRISANIE
® MY COMMISSION N HH3174
EXPIRES: May 25, 2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21