HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Planning and Development Services
Building and Code Regulation Division Commercial Residential y.,t -
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78 CBDG Funding
PERMIT APPLICATION FOR:
ER }I nS D IIVI ?R01lEMENT LOCATION
Address: -I o ALa. ,n g,,5 ,-
Property Tax ID #: 3 N I �J -Q-0 1- 1067 - DAP — cj Lot No. -1
Site Plan Name: 1-kc ri 0. Cr,4 h,&r - C IeJSi;&.n S 6,n4::o n W ly Block No.2
Project Name: C, r ► a. Y `(4 „ t` r; �k , g.61 So.����e lJ
AliC C�on,GQ rUt,.+ Co.rrtor - On 00 %Q0V-
V /GUUCGrVIf I
�OoS�
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
AMechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ Z3 to o-z)
Gas Piping
Sprinklers
_ Shutters
(Affidavit required)
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name LA- o,,r i C•- Crew A P f
Address: -1a7_ -5)a �n •�� 1 r
City: P,�r � S l �..L. :L State: C-C
Zip Code: W to 015 % Fax:
Phone No.'lVo- yg0 - I, S7 E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Se(: rdu 5 ,rn�.-•
Company: L.t r,A ,rD,,,. �/� ; r C m%&Ii i Ort oq
Address: 35irm to hA. ,=r�l��i_ 0-A
City: eo---n�& 6166 State: C-L
Zip Code: 3 7o G 9 Fax:
Phone No i'1'L-moo ^�(08g
E-Mailc�c�\ �P� Li r�,S�rorv.A �P�
State or County License C44 C-�O f5(o Ct -1 t
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
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
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.
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 conflicts with any applicable Homeowners Association 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. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory strut swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNINrender
0 O NER: Your failure to Record a Notice of Commencement may result in paying twice for
impr,men s to your property, A Notice of Commencement must be recorded in the public records of St.
Lucieunty Ind posted on the jobsite before the first inspection. If you.intend to obtain financing, consult
with arlattorkev before commencing work'nr rernrdinp vnur Nntirp of Cnmmanramant
IYU.o14,ay
rue,
DULCE MARTINEZ
Signatu f ner e e ontractor as Agent for Owner
* o*
Commission#HH 119702
NT9rFOFF
Expires May 10, 2025
STATE O ORI A
P\�Q
Bonded 7tgUeWgetNotaryServices
COUNT F
Sworn to (or affirmed) and ubscribed before me of a""Physical Presence or
Online Notarization
this T day of it _, 20 -41 by
Name of person making statement,
Per' a ly Known Ad(X . OR P oduc d Identification
Typ of dentifi ation Produce
(Signature of Notary Public Stat of Florida)
Commission No. (Seal)
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