HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 311r$ Vi f9 Ave -'Fb✓'11- 6'4CG -L� 3ygga-
Property Tax ID #: bb 1 - OD,;? -- a
OLQD - D Lot No. q - 31
CSgail-
Site Plan Name: G d I la r-/J G gad Block No. _A
Project Name: I ( i
ETAILED DESCRIPTION OF WORK:
P,Gr►ove. GjCS�tAq6h;J14le Wof ws4all ay I and Sold UAA la 42 z
in azzo 5610
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 v ` Roof Pitch
Total Sq. Ft of Construction: 3--00 Sq. Ft. of First Floor:
�r
Cost of Construction: $ � f Q00.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSE ICONTRACTOR:
Name Lo and (Aeal
Name: 'DLI/ G ✓O
Address: 31 gir Ljia a V; 57-R AV e
Company: 'The G- al Or'�
City: Ff)r+ 'P U'Gf State: FL
Address: W/D SE LI/Q�✓!iJ St
Zip Code: 34 Fax:
City: `�JUQYf State:)=L
Phone No. 3-70 — O 1 gS E-
Zip Code: Fax:
Phone No q-?,,--$�a�l`1030
Mail:OTU>h7r'fS�Y�+LinGfri//DD�i„iLl
Fill in fee simple Title Holder on next page (if different
E-Mail �pjl/°7�fs�%%IL/+1l�al/dDLUot�
from the Owner listed above)
a
State or County LicenseCl33.;L3`i6
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.
SUPPLEMENTAL CONSTRUCTION LiEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name-
MORTGAGECO ANY: _Not Applicable
Nam
Address:
Ad e
State:
pI Phone
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _NotApplic le
Name
BONDiNGCOMPANY: _Not Applicable
ame•
Address
City:
Zip: Phone:
Address:
City:
Tip: _Phone: I
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 permtt
5t Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which ronfltar with anY all licable Homeowners Pssoclatlan rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu�t Tr cable
your Homeowners Association and review your deed for any restrictions wbirh may apply.
in consideration of the granting of this requested permit, I do hereby agree that t 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,l
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 p d on the jobsite before the first inspection. if you intend to obtain financing, consult
.4: U t.....i..-..... n., hefnro r,mmcn,4na tunrle nr rprnrrlino Vnttr Nntirp of Commencement.
YY,MI ,V..0 V. •.
Dvtcc 649jq-
Signa wrier/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
PA101 6ca-C--kI
COUNTYOF
Swom to (or affirmed) and subscribed before me of �hyslcal Presence or _ Online Notarization
this LOMLday of S&O = 2O2I by
Dvtc.s L-44-4
Name of person making statement r
1
Personally Known —�K,_OR Produced Identification
of Identification uced
I
tgn re of Notary Public- $ e of Florida)
bac State of Florida
,;°'%+ Notary PL1�Maria A Molina
CO On NO. (seal) k fi
pv 61y ccwica GG 211062
'03�no%
'spires b42's12a22
REVIEWS
FROM
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev S/20/ll