HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I la 1, a-0 2I Permit
Number:
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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:
PROPOSED IMPROVEMENT LOCATION:
Address: % G' I-__� r-e�C:.��
Property Tax ID #: C) GC~i C) Lot No. <3 +
Site Plan Name: Block No. /-IT'
Project Name: q'\�
����DESCRIPTION OF WORK:
is C:� c
vL,f
New Electrical Meter `l c> Second Electrical Meter ;"La ; _ (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
ii
_ Electric _plumbing ,Sprinklers _ Generator Roof t i � Pitch
Total Sq. Ft of Construction: ��� Sq. Ft. of First Floor: I���
Cost of Construction: $ , 00Q , c.> t> Utilities: Sewer _Septic Building Height:
-�
OWNERAESSEE:
CONTRACTOR:
Name: _'.t'XCLI` 6k c3 c
Name
Address: 1 I~; I-c
Company:�t a-�
}
_
city: ..� . F I I`C State: �-L_
Address: __�2_0 L`(11
Zip Code: C%9131Fax:
City: \y -e Y''-IN II )_CkA_ Stater
Phone No.
Zip Code: C1 to 'Z?k Fax:
E-Mail:
Phone No i - _ -
Fill in fee simple Title Holder on next page ( if different
E-Mail (-I C'_h -L Cr)e_ Hi
from the Owner listed above)
State or County License CC C.. I� �, (o
Nl
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
Name: N PC,
MORTGAGE CQI PANY: _ Not Applicable
Name: J / IN
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING C'�Cq� PANY: Not Applicable
Name:_ /k
Name: IV
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
rules, 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 arLattorney before commencing work or recording our Notice of Commencement.
a
Signature of owner/ Le ee/Con ac or as Agent for Owner
STATE OF FLORIDA
COUNTY OFi. �.
Sworn to (or affirmAd) and subscribed before me ofy Physical Presence or Online Notarization
this _ C&.- day of 2VA by
`
` C 'G�ir 'C C�' L
Name of person making statement.
X
Personally Known OR Produced Identification
Type of Identifi ti o c d
(Signature of otary u c- e of Florida)
�--r
THERWEHqufNS y
Commission No. (Seal) «2,gr
MISSION #rOg165030;,RES:
DEC 04, 2021rough
:EX
1st State Insurarue
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev