HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L 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 CBDG Funding
PERMIT APPLICATION FOR: C- Lec*-,--, c:« I
PROPOSED IMPROVEMENT LOCATION:
X-
Address: S--74y I 1- S C'�_�, ry_i t�ti.�rt� L �►{�i�Z '"C+-10
Property Tax ID #: ' 10 4.� cx.I Lot No.
Site Plan Name: 1,Ao 1l Block No.
Project Name: H 0 w-C I(
DETAILED DESCRIPTION OF WORK:
1CA,eV 1C,s .r,,n uw_:.� C
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 _ Shutters
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ < Q6 . c? C)
(Affidavit required)
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name yr eP r w 3k lle 14uu )eff J
Name:
Address: 5 �6"V-19 i 4 t= y"&S
Company: -+y, ,'�,-L,t..
Address: 33 5 Z VI
C i t Y: Q:t V-+S-k'n r`�L-erxC_e':
Zip Code: '3 Lci 5 "7
P laef-hto W-a L:
E-Mail -,s1_h S-?33
C 4 car-,z- L L c_
State: FL --
far. [xc_qll'-7-72-?C4 �2sc
S 60 - b- u 3 -- 5 3 7 3
cep ev'l
City: _j-v �- t ;'P r L :- _ State: T- c-
Zip Code:.3LLEI Ya For.
Phone No. -1 q - S_? 1 E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License_
SI-G�G `5 C,
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 Applica
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. Lucle County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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�a"n attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lesse.. ontraetor as Agent for Owri
STATE OF FLORIDA
COUNTY OF C-- -
Sworn to (or affirmed) and subscribed before me of L4r ysJcal Presence or Online Notarization
thislr tf-day of At. � ; y 20Z_L by
—
Name of person making statement.
Personally Known L-----OR Produced Identification
✓
Type of Identification Produced 1 1r,r, (.1 c._
.___
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
KARENCODERRE
MY COMMISSION # GG 981001
.;
EXPIRES: Apol 23, 2024
•'..d Bonded Thru Nolary Public Undenwdters
REVIEWS FRONT ZONING
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW
REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED I
DATE
i
COMPLETED
iev 5/20/21