HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L " ij;� I: L� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78
PERMIT APPLICATION FOR: 1 t ry-\611 +10
PROPOSED IMPROVEMENT LOCATION:
Address: '2
vl
Property Tax ID#: N3%- SO l -Ci4 I 606-G�
Site Plan Name: !?G.0 V-A!�Ae
Project Name:
Lot No. +QLO u
Block No.
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter glh_ Second Electrical Meter_ (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply: N
_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: $ 2 k Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameI.�l Cktt O C
Name: G,lC* , 12e
Address' 2�3 Sr L•VGi G Q)V
�7
Company: C11 iQ9 Grww dX Cow fc\c�Cr ti`i CO(9FI
City: fo Y- I— 4( Y- C. t . State::L.
Zip Code: 411%14 (e Fax:
Phone No. (b\ s-� 1018 b
Address: l c:)QJ G WctA,��C, SA- .
City: 01 - 'c G:-"otg-tfi Stater
Zip Code: 3 90�-4-q Fax:
Phone No �6L43"Liq::1 -`;0001
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ilol r v w
State or County License(y--C Ql j-1 k
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: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 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 attorneybefore commencingwork or recordin our Notice of Commencement.
04wte "
Sig re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF A 1
,,
COUNTY OF
Swore to (or affirme ) and subscribed bef re me of `! Physical Presence or Online Notarization
this day of , 20e?k by
Name of person making statement.
Personally Known ✓�{ p c d Identification
T e of Identificatio Y"Yf 4UCE6
ZZLL
(SignItilre of of a of Florid )
'0....: �,:, TIFFANY RENEE DENTON
• G 263842
Commi (Seal) MY COMMISSION 6 G 11
EXPIRES: July 31, 2022
'Ce°spy°t`
Bonded Thru Notary Public Underxdlors
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21