HomeMy WebLinkAboutBUILDING PERMIT APPLICATION F I
AII-APPLICABLE INFO MUST BE COMPLETED FM APPLICATION TO BE ACCEPTED..
Date: V` ��' `
EI
I - T Building Permifi Applicati®n
Planning and Developmen.t5erwtes
Wlding,and Code Regulation Division Commercial' Resadeni aI ^
2300 Virginia Avenue;Fort-Pierce FL 34982
Pi one:.(772)-462-1553 Fax:,(772)462-1578
PERMIT APPLICATION:FQR
PROPOSEQ IMI?ROVEMENT�LC7'CATION r � � £ - ��� � `�
Address: 'Tt3C� . ��r,e- r c c:��[� t=w-t P Le. -cor
Property ID#:
1 Tax Lot. '
N o: r �-
Site Plan Name:. Block No.
_. .
Project Name:
DETAILED DESCRIPTION ,OF WORK
.. k� . .
Wti dy� C_ t(. { a_1" 3
Nei Electrical Meter X Second Electrical Meter .
Y D
CON ,RUCi"ItJN INFORMATIONS n
K a
Additional work to be performed under this permit—check.all'that apply:
)(Mechanical Gas Tank _Gas Piping- =Shutters _Windows/Doors Pond
'Electric 41Plumbing. —Sprinklers _Generator �Roof Pitch-
. .. .. . .
Total S,q Ft.of Construction:_ o�, q SS. Sq. Ft. of F"first.Floor::. j,955
Colt`ofConstructi.on:$ as , 52's Utilities: _Sewer ✓Septic Building Height:
OIIUNERjLESSEE _ CONTRA
NameM��p , J�^ }Imcse to 4-� Name:
A ,� ,� ��/�Address: 1 t_5 S S csv, ham- Company:
City: (ESL State:.PL Address: _t.l S�J i�SL : 1C9t .
Zip Code:--SA> Fax: City: 5- State:
Plhone..No._ .-J, r<4 q� t.QS o Zip Code: r33 Fax:
E=Mail.'S�nood.�i'1 t�bt1LSt Phone No
Fill in fee simple Title.Haldeer:ori next'page{if'different, E-Mail T
from the Owrier listed above
} � State or County License �(
If value of construction is 2500 or`more,a.RECORDED Notice of Commencement is requited.
If value of HAV.C:is$7,500 or more,a RECORDED Notice:of Commencement is required..
i
r> � u � ' + =
UPPEEI fEN (.Cal STf QN LI 1E E�AUU i t ORM1_lAT( 3 � �
a _.'pS'` z.a_s ... 3...u. >v°� t..3.:
_F
DESIGNER/ENGIN.EER: _,Not.Appl'icable MORTGAGECOMPANY' _-Not.Applicabl'e
Name:. &e4-s ?Name:
Addness: S 14 9" Grrr ol Address:
City: State: ° - City:. State:
Zip: 5L0,11 Phone ,.q `-u--�- ako3 S Zip;:.. Phone:
FEE SIMPLE TITLE,HOLDER: %-Plot Applicable BONDING COMPANY: `It1ot Applicable
Name, Name:
Address: Address:
City: City.
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:.Application is hereby'made to obtain a permit to,clQthe work-and installation as indicated.
I certify,that ngwork.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 m'ay`appiy.
In consideration of the.granting of this requested,permit; I do hereby agree that 1 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 faifure 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 recordin Notice of C mmencem.ent.
Signat e:ofOwner/'Lesse / ontracto ' s� gent for Owner Signatu fContractor/Licen ;Hol'ler-
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY'OF, A—,--CA 4,,
Sworn to(or affirmed).and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_Y Fhysicai Presence or Online Notarization Physical Presence or Online Notarization
this i dayof. �Ask ,2024'by this 1 u dayof i �►•ex - 202�:by,
Name of person making statement. Name of person making statement. -
Personally-Known Y,- OR Produced Identification Personally Known �i� OR Produced Identification
Type of Identification. Type of Identification.
Produced . Produced
(Signature of Notd`. ._Public-Stateo rida,) (Signature of N' ry Public-S of Florida )
I1 y Kelly Fide
Commission No. `{ �f �St t.v (Se Notary Pub cCommission No. �( p�aZ 50(,P Kelly
—State of Flo ida a Notary Public
-� 2506 a state of florid
19 Expires 1/ /2025 �s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTL "MA � �/
COUNTER RE1/CEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED -
Rev.