HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ) 't C: f� fc. f, ; .<,_
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Property Tax ID#: 1.31A —,J�LZ.-4ctC 'UL
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
—Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ r24��Q v
i�
Lot No.
Block No.
_ Windows/Doors Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name--Ia.;h�i.:YYji ''if--tC ;,:url 4:'_
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Name: i.L-;f/-Fo."�/
Company: l,lr F{, ; r�
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_
Address: Sif S ri `1 2;LI r-f 1 {�- /' l •
City: L� �`. 19, & (` e.L State: (
Zip Code: 3 N q-t r` Fax:
Phone No. % 1 Z - AFL' $ j/ '' E-
Address:
-
City: ALP State:
Zip Code: i 3 Fax:
Phone No %%L-y % 3� ; Z`>/�
Mail ;CiLrCf(4 tt:,r ci
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C4 , i i . ^ (- f %i :�`''f C. ✓- C C c t
State or County License = L% t O �'
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va,am w uauao v�uuu ,b Lwu or more, a Ktwnutu nonce 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:
Name: _
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
1W IUCG / rnuron/•rn.. w ��.....
MORTGAGE COMPANY: Not Applicable
Name:
Address:
t,Ity: State:
ZIP: Phone:
BONDING COMPANY:
Name: _
Address:
City: _
ZIP:
Phone:
_Not Applicable
...........rr,iwu�n n nereuy maae to ootam 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 8ranting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable HomeownersFAssociation 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. Lurie 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 attorne before commencin L.
wor or recoiding your Notice of Commencement.
C.P.. arr P� Jj
Signature of er/ Lessee/Contrac s Agent for Owner
STATE OF FLORIDA
COUNTYOF
_1-\C�to�4\ J?�
Swomy for affirmssdI ..and subscribed before me of �Ph ysical Presence or_ Online Notarization
this =r day of_'�c�p� "e-- 2021 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
C
(Signature of Vbtary Public- State of Florida) KELLEY MCCABE
MV C 250028
Commission No. �. (Seal)
PIKES: AUG19,
EXPIRES: UG 18, 2G22
22
Bonded through tst State Insurance
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