HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Z� l2, Permit Number: & - n ( .0908
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: F�11'1C� — (-\ ' Gnakln
PROPOSED IM'PROVEM'ENT LOCATION:
e
Address: woo D) and U V Y'-1 R V VeVT.e q 3 415
Property Tax ID #: t �O-L Uw — Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
.a Yn s Lt' Qac In Vim t,� L
12' GOif'50J hn S \dle Li ' GQa� . hcN %�% S d e an
' ! cea -2 east SOR"',
New Electrical Meter Second Electrical Meter (Affidavit required)
sCONSTRUCTION""INFORMATION: .
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ cS I LPM • 00 Utilities: —Sewer _Septic Building Height:
OW , EVLESSEE: <
'
CONTRACTO.R: ; '
Name isles
Name:
Address: lo0 R cad
Company:
Address:
City: State:
Zip Code: Fax:
City: _ 'P0 a f 1State:
Zip Code: ��ulqLIS Fax:
Phone No. -IZZ ?'m (12S
E-Mail: -tie 2ky) Lx U !S U1."- {/f f
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
u VdILIC u1 Lunstrucuun is couu or more, a 11MUKutu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
P—J— V --7( 6 T (A NO 01 cx�-
.SUPPLEMENTAL CONSTRUCTION LIEN 'LAW INFORMATION: -
DESIGNER/ENGINEER:. _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 erore corrVnencing wfflrK
or r
Zment.
_� e�;State of Florida -Notary Public
T�� /4- /1/_*
. Commission # GG 207484
%� My Commission Expires
Signature of O er/ Lessee/ ractor gent for
oa°,'
°'�°�� �" % June 12, 2022
STATE OF FLORIDA 1 . ,
COUNTYOF
'
ICt
Sworn to (or affirmed) and subscribed before me of X
Physical Presence or Online Notarization
this Zq day of 3U0 202 by
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Commission No. tilA 00 WM AMANDABEIHMAGGART
(Seal) ::X"g
Csi.,:
Commission
# 1 008693
;,• : ,:
=' o" Expires June 10, 2024
�'•'•:rdv f; �"'' Borbed Tlw Troy Fein I�mmenoe 8003857019
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