HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 61 2- ZI Permit Number:
O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
230b Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-2578
PERMIT APPLICATION FOR:
PA�PQSEQ 1 [I�Rt3�/EI1lCENT�Q�ATf�i�t = =
Address: y73 ' f Vl&'5 h �7y-_ 3�_4 1&0
Property Tax ID#: _3_5 Z 1-80"t - 60( 40 ` wo _J Lot No. .53
Site Plan Name: ((1 A� � Block No.
Project Name:
Qi=T 4 LE I} SCR`lPTI N.0F_. _OR€f.
New Electrical Meter Second Electrical Meter
CONSTRUCT- 1
t?N INi-ORMATION:
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 5q. Ft of Construction: Sq.Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWN E TRC
NameI/C}Y'tPXI �r+� Name,
Address: W A- Company: " t
city: Fu—+ State: L Address:(J F�50 t'
Zip Code:?�499_ Fax: City: ("-'C_*, J_"Cte State:
Phone No. -o ' 7 -22 1 `7 Zip Code:3Lq�5 Fax:
E-MaiI: Phone No al
Fill in fee simple Title Holder on next rage(if different E-Mai1 M;N
from the Owner listed above) State or County License CIF'C 1L4 3.51
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.
Name: RjENCsINfER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: —
:'Address: Address
City: State: City: State:
Zip Rhone Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address- Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
1'tertlfy 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 Horne Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Tease 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 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 accessary 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 pasted on th jobsite before the first inspection.If you irltend to obtain financing,consult
witNiender or an attomev QIVa commencing work or recordingAour NcAlce Qf Com cement.
/Ayd
Sighature of Owner/Lessee ntractor as Agent for Owner Signatu of Contra /License H I r
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF t LUCA, c' COUNTY OF ST-L.Uc-4 'e.
Stpro�n to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
V Physical P en a or Online Notarization Physical Pr ence or Online Notarization
this day of 202 by this day o 2026 by
Name of person making statement. Name of person making statement. !
Personally Known V OR Produced ldermfficatlon Personally Known V/ OR Produced Identification
Type of Identification - Type of Identification
Produced Produced
AOL—
Signature of Notary Pu v*r " titAttE C0LE Signature of Notary Public-State of DIANE col
. Notary Pubtk-Stat o forida
_;F = No State of Florida ` " trumntssim,#GG 84 Commission No. �€ c ti GG%1099 Commission No. = /gyp tame.Expires r 202,
My Comm.Expires Mar 14,2024 6aided through National I otHy Arm
Bonded National Notary Assn.
REVIEWS FRONT >. ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.