HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��O - �OL4 �� Permit Number:
'- I
' 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: �Proa/%fibn
PROPOSED IMPROVEMENT LOCATION: C/ ?
Address: R)41 131v-61 Sente.7
Property Tax ID#: L15-02 - 5,01- DO6 5-'000 " 41 Lot No.Za2-
Site Plan Name: /1�e#1'-Y �ZfI4.'w Block No.
Project Name: 20 012
DETAILED DESCRIPTION OF WORK:
Cory,0le rye deyv o ?On a "mo-yw I 4 -ic e4_a,�%lP X o.-,e ` 0 l D60h9 ,
eawe_ le
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 i Pond
`Electric Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: 9y Sq. Ft. of First Floor: 1O 2-
Cost of Construction: $ /00.. Utilities: > Sewer _Septic Building Height: 9�7<
OWNERAESSEE: 1 CONTRACTOR:
Name Z-4rrx Al Name: Ala M 5;;i f 4
Address: Z042 ✓fie#1,el Rlva/ _ Company: ��w,,, J�+r;�� t6ru� �U<• i�f.
City: J Gn fCA State: • Address: 6I 4 • A Leer f7e.
Zip Code: 3 �f757 Fax: City: ;/ernfe/n Re—e- State:
Phone No. 90- FOP G 5'33 E- Zip Code: 3 Z%5_7 Fax: 772'.23Z-2191
Mail: Phone No '772" 2-ZO -371.J
Fill in fee simple Title Holder on next page (if different E-Mail <c41aM Soo c 6-) V4lia4• Cz,-1
from the Owner listed above, State or County License Cf8C 12 S/9t31
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.
SUPPL NTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGI r Not Applicable MORTGAGE COMPANY- i Not Applicable
Name: Name:
Address: Addres
City: State. State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Applicable B ING COMPANY: _Not Applicable i
Name: Name:
Address: Address:
City: City:
Zip: Rhone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and in Ilation 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 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 attornev befwe commencing work or recording our Notice of Commencement.
i
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF /
Sworn to(or affirmed)and subscribed before me of \4hysical Presence or Online Notarization
this day of '}{ 213� by
�d n,-�
Name of person making statement.
Personally Known OR Produced Identification ! t o t'r d L L-=
Type of Identification Produced, r-',d D L—
(Signature of Not ry Public-State of Florida)
i t03 Pie MARY LEE MATTIS
Commission NoA L,81 YQ (Seal) �° `'�
Commission#HH 089498
Expires March 6,2025
�TFOF VJ1, Bonded Thu Budget Notary Services
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Rev 5 2 21