HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
P �01 C 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: 5 , IT ,-4I
Property Tax ID #: ''�' �' Lot No. J7 � ` o
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION 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:
Cost of Construction: $
OWNERAESSEE:
Name
Address: I SJ 7�
City:. 4 State:
Zip Code: 3 �l�`b -� Fax:
Phone No. I'I &(%-3
E-Mail:
(Affidavit required)
Shutters —Windows/Doors
Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: jy\ Lj `mac,, �., LS
Company: 'f' 54
Address:
City: State: I .
Zip Code: `1� �� Fax:
Phone No 44 Z-1 -
r
E-Mail —
State or County License
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: ► 1ne, �C
Address: Soh i n 4a; " e 9= State:
City: ►c-w�a a-- Staate: Zip: 33P Phone ff�-9tZ07
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip:
one:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
__i_ .....-1 :...,t-.11 ,+inn — inriirntorl
OWNER/ CONTRACTOR AFFID I : Application is hereby ma e
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 orprohibit 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 recording our Notice of Commencement.
Signature of owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF ST LIW E
6 Physical Presence or Online Notarization
Sworn or affirmed) and subscribed before me of
this�dayof /414G4s7 J202/� by
MA K Ks
Name of person making statement.
Personally Known v OR Produced Identification
Type of Identification Produced
f
(Signature of Notary Public- State of Florida) RUTH HOLMAN
►,RY
Commission No. . (rGg �� C�/D (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
�N NOTARY PUBLIC
�! ESTATE OF FLORIDA
a Comm# GG973640
7NCE 1P Expires 3/26/2024
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
SEATURTLE I MANGROVE
REVIEW REVIEW