HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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: -79 l O 156 eve- , E L
Property Tax ID #: i 3O I - lod3 -00-14 - Oo0 5
Site Plan Name:
Project Name: PkuAmmzv . 'P-, D of - C) 1 Z I -1r-�
DETAILED DESCRIPTION OF WORK:
Lot No. H VS
Block No. I Q�
emX)v2 unCA vcpla.C-e— I —I S.SJ Aav�QS 41 L2
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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: 1 -1 O O
Cost of Construction: $ i3, 13-1- mot,
Sq. Ft. of First Floor:
Utilities: —Sewer
OWNER/LESSEE:
Name \�onc64. t W ;11ia+rrn plamrvI-a--v
Address: -1 `t 10 GmRS p-
City: ov -I- State: F L
Zip Code: '�4'9 5 I Fax:
Phone No. -112 - 33 2 - to 1Z 5
E-Mail: VonACLPivmw'a'e ma"k �m
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
1 -1 44
Septic
CONTRACTOR:
Building Height: -1
Name: R-nda I I li?, . v-e.
Company: ?vu\0-ev4(LenavativvlT anJ CanS4-vuc,r,-
Add ress: 21;00 S. A4Qv6�,, c k4 T31.yc1 .
City: M z160,- v tee.. State:'F L-
Zip Code: -62-clo 1 Fax:
Phone No 32 1 - y 2.1 - lO 3 -1 L4
E-Mail Ai,oE;�Prc CFIa . c orrm
State or County License G(f-r- I S2.9 $ 0 1
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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: _state:
Zip: Phone _ Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: -
Not Applicable
BONDING COMPANY:
Name:
Address: _
Citv:
Zip: Phon(
Not Applicable
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 recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF ,.3 ft 1 b`ct
Sworn to (or affirm ) and subsc 'b
this lIL"1't1hyof
Name of person making statement.
I before me of
20_<Wby
Personally Known R Produced Identification
Tvae of IdentificalM rodulced
Physical Presence or Online Notarization
(Si nature of NotaTy Public- State of FI )
� 7 L0.)
+ ` ; rw KIM E. RINssion GE
Commission No. 7L (Seal) :*. ;=Commisswn#HH098243
a = Expires May 22, 2025
oR ,, BorWW Thru Troy Fain Insurance 800.3954019
I
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