HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C6 ' U-2,1 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Residential
Address: ,5YY16l11 WO odl PNG
Property Tax ID #: 3 A-0 3 --- 805 " O 1 42 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
(.p (Z r v mc x 46r- ro n dcn w c.-% r�s ia[e••ce
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank Gas Piping Shutters
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors Pond
Roof Pitch
Cost of Construction: $ 000. Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name I(a✓1 ffi, &!fyj* c4cw c, _
zT
Name: MWaAG( Pvq r ac
Address: 222 Smc.Alwoo
Company: FKictt eCCA-r1re,-( SC,-oeVtLeso+-(r
City: 1_::7TJe-r State: E�r
Address: 6—+?;! S IG -fidS Hwj OZ^Q
Zip Code: 3�i"q � Z Fax:
City: f^'t- . p lGr4e, State: F7-2..
Phone No.
Zip Code: 54G45 Fax: —77Z • 41ol • L7� $
E-Mail:
Phone No 212 • 31 0 • 100qy
Fill in fee simple Title Holder on next page if different
E-Mail Y1'1►lC CO' (2/'1ICG'f'Vi CC� ' COW
from the Owner listed above)
State or County License 130 D 585�
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:
City: State:
Zip: Phone
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 the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attor v be ,ore commencing work or recording vour Notice of Commencement.
SignafEur� of Owner/ Less ee/tofhtractor as Agent for Owner
STATE
COUNTY OF OFORIDA
Swor t r affirme }and subscri ed before me of Physical Presence or Online Notarization
this Pday of �iU . Z--? , 2091 by
Name of person making st tement.
Personally Known OR Produced Identification
Type of Ides 'ficati Produced
T
(Signature of Notary Public- State of Florida }
Commission No..j4 q��(Sea i )
k1my DeAnn A. Prue
NOTARY PUBLIC
STATE OF FLORIDA
• Comm# GG926989
Expires 11 /13/2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21