HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number.
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a ti
°' 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: C'
PROPOSED IMPROVEMENT LOCATION:
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Address: o�� �.� t,� ��.r 4• - ,.. � � [.�- - --. -Q� :��• � ,..�
Property Tax ID #: ail c) ; I r _ , ; _ -D- Lot No.
Site Plan Name: r7 r Block No.
Project Name: 5; ,
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
ECONS-IFRYCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction
(Affidavit required)
Shutters _ Windows/Doors — Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ a 0 Q. _0 0 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
Name S s- I
Address: -) 'r `,l S, Iv f v i'o • Y. i). + V
City: _c<- :.: State: W\T:
Zip Code: ss Fax:
Phone No. ` I IS `-i c-i U 'i 5 `i
E-Mail: ��= � 5 c ,r - cv `Y1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:_
Address: -3- 5_2 k) C S It V L_, v;..E
City: .:Le �� S rr (�t �s State: it -
Zip Code: 'Z q C1 ��l Fa*: ��_kt Fs_-roo _8 63 -S 3
Phone No OrC_ f# -]-I 2csi - o'zi-' o
E-Mail Lk ID 5 3-5 3 cp :�4 v-Y-e�' , I, C. ova ,
State or County License
(r„,,,-O--ti CLC_ 3 G,S -71
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 LAIN INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: -
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
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 attorney before commencing work or record in our Notice of Commencement.
'Irg—mature of Owner/ Les e/Contractor as Agent for OwriT]�
STATE OF FLORIDA
COUNTY OF n
Sworn to (or affirmed) and subscribed before me of Z Physical Presence or Online Notarization
this &� day of A e, 2fl? 11 by
_ .max —) r- v
Name of person making statement.
Personally Known r OR Produced Identification
Type of Identification Produced f I t1 r : d c— _Dr, vc ✓s ' l,1' c,., S9-
(Signature of Notary Public- State of Florida )
Commission No.0 G r $ I ac k (Seal) �A IURENCO
+: .. MyMyCOMMISSION � GG GG 981001
:•: EXPIRES: April 23, 2024
"•' •* Yerrled Thru ►notary Public UndenwrlUrs
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EVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW , REVIEW REVIEW REVIEW REVIEW REVIEW
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CEIVED
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MPLETED
Rev 5/20/21
Rev 5/20/21