HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -,)-/ Permit Number:
P L c F L c, C�,, ' - 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:
PROPOSED IMPROVEMENT LOCATION: _
Address: q6-6(] U Oega/r� uV',,r d �`fOJ _)6LQP ���� �� TW6 7
Property Tax ID #: /-���>� (vQ.2 _ () J&,__2 ' 000 - g Lot No.
Site Plan Name: A 0 Block No.
Project Name: Chi
DETAILED DESCRIPTION OF WORK:
UY t l..l �i/l_ l,, •r vL 1 - 1 1 I W t
4/6 - �A / e" ll e f2n, hul M- - C� !-
r _..! ( t
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 _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6 s-o - Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name (A H
h LI Y t
.. I
Name: "i
, .lei (�s(-
Address: . �i✓ C' �/ Y -_ L
Company: �C Il L �cr
IAIV Jy /A- l
City: "' Ce seo 1 ka r t' � State:-
Zip Code: ,�yGi'S / Fax:
Phone No. C8�1_ !�ZLS - qf� 41- E-
Address:I (E_ LVr .^ IAC,'
City: oml I
Zip Code:
Phone No
State: !/
Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail I'
C 01; (64 Y--\
State or County License
I t' - %C/ j 7WqC)
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.
DESIGNER/ENGINEER: _ Not Applicable
Name: tj
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address:
City
Zip Phone:
Not Applicable
State:
Not Applicable 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. 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 rev:cv., your deea for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby a ae that I will; in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes anc :.. l.!acie 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
"WARNINC TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
1YITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE f)F COMMENCEMENT."
Signatur o wner� Lessee/Contractor as Agent for Owner
Signnaat�d re of Contractor/License
Holder
STATE OF FLORIDA c J
STATE OF FLORIDA
COUNTY OF �) h�I�
COUNTY OF
The fpor,� oing instrume t was cknowledged before me
this day of 20� by
The f ing instrume
this ivy of
as ac nowledged before me
20.7-1 by
�
7TOS WOL�y) /O w
�uv If
r Leal 1 U')
Name of persoh making statement.
Name of person 6aking
statement.
Personallv Known X OR Produced Identificatinn
PPr,onally Known k
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
i
(Sign ture of Notary Pu F
igna ure of Notary Public- St e of 40"a, : APRILBRUMLEY
C nission # GG 208194
'+.•....P 47�
,. Ci�mmis m # GG 2081
'• 'I sAprill17,2022
Commission No. , BonIruroy F f�sunnce>!00 385 7
m m i ss i o n N o.
-'.,FOF�'" �11nu T Fan
�Y
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 1/ // 19