HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: F i(V INA ! Permit Number:
SAo LLUIC�
U7 7 1 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 4l ,5 �5,ate _ ��-Ir 5+. 1—LA, .i — 3
Property Tax ID #: 3 3 i ' 7 07 -- Q0 l 9 }
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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I Y� q—by� ; LQ. �5 e t� ! O KJ 1
1 r o�,n 15 I k e uJ r 5 R
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit —check all that apply:
VIlechanical _ Gas Tank —Gas Piping Shutters —Windows/Doors
— Electric —Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: Z>O ')
INER/LESSEE:
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Name J lk-rxWZ�� k_CtZW
Address: 161 LQ. 0.S5
City: bFT S4. Lali �2 State: R
Zip Code: %L{'I 3Lp Fax:
Phone No. qJ4 3 - 3 Ole ' 1 J o q
E-Mai I:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Lot No. ! S
Block No.
Building Height:
Pond
Pitch
CONTRACTOR:
Name:_ �0im
Company: h PASczzlk (10,?�
Address: (RDDT
^^
City: 4� . PevJ _-e_ State: El
l•
Zip Code: ?;�q "F5 Fax: TQ " Qom'
Phone No 7 7 A - 6A 7 - .3377
E-Mail n5 GbC7l i CQl'yl
State or County License CA-r-- LP57 o?LPY/I
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.
C. .
SUPPLEMENT -AL 1;f1 ENTAL CONSTRUCT[ LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable pp
Name:
MORTGAGE COMPANY: � Nat Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: � Nat Applicable
Name:
BONDING COMPANY: Not Applicable
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 OWNED: 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 pd posted on the jobsite before the first inspection. if you intend to obtain financing, consult
with lende r ao attorney before commencing work or recording yoyr Noce of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
e of Contractor/License Holder
TATE OF FLORID
STATE OF FLORIDA -
COUNTY OF L--� [ Q=- --
COUNTY OF �:4,�-L1 C,------- ---
Swo�rto (or affirmed) and subscribed before me of
i
Swor to (or affirmed) and subscribed before me of
Physical Prese ce or online Notarization
Physical Presenceor Online Notarization
this � day of 2021 by
this �Q day of 2024 by
2X41ov,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V-OOR Produced Identification
Type of Identification
yo Identification /
Produced U11��
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Produceds1
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per. � i1SSIiJ1U.�Y �'/
a-'sG�{iu raRr�_
�gnature of Notary Public- State of
signature of Notary Public- State of Florida
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Commission No. QQ S•a
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Lmmissian No.�� Ole Sl
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