HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: 9 - 1 Q- 21 Permit Number: ` -ODD
LUCE
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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:
PnRC}POS€D IMPROVEM.ENT LOCATIQN
Address t 'S -��i�•�t� s��
Property Tax ID#: V Lot No.
Site Plan Name: 'RS iq Block No.
Project Name:
DETAILED DESCRIPTION:�OF WORK
- of G &O L -r Kv u w
I�-2 I i I `�'� ' fr -' �l�l a crZ�
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION ;; F . 777
Additional work to be performed under this permit-check all that apply:
Mechanical Gas Tank _Gas Piping —Shutters _Windows/Doors _Pond
v Electric —Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: 12- ® toe Sq. Ft. of First Floor: f v �
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
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OWNER/LESSEE: s° CO.NTRACTOR:
Name 77,`�- !A-1 �� �Gr Name: "T6- 44 szll�
Address: ` Id�B° �19'd Qi Company: 6 lam►r-�
City: State: Address: `r,? Zl 5 6` —
Zip Code: .3 L! Fax: City: jU11 CE Stater
Phone No. 7 ? 7— 7 ` 3 l 'L Zip Code: 1 4 -7 Fax: 7?2- 7e54 12- 3
E-Mail: S IN !!JA,; - 5" *f Phone No 77& & 3 1 12ele�
Fill in fee simple Title 161der on next page (if 4ifferent E-Mail Z-I'(Z i kUl - 0--C7p''L
from the Owner listed, above) State or County License C- ep&z&'-,�
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.
,44
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATICI�
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 hoiderto 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 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 attorney before commencing work or recording our Notice-of Commencement.
? nature of wner/Les ee/Contr as Agent for Owner
STATE OF FLORIDA cry, /
COUNTY OF / 'I 1iLCC4
Sworn to(or affirmed)Wd subscribed before me of Physical Presence or Online Notarization
this Z day'of 2002( by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
� n ,
(Signature of Notary Public-State of Florida) -
Co .rp�i �I ar�No. ELLEN VAUGHN eal)
;2° °, State of F ta lorida-Nory Public
=* *_ Commission # GG 270079
i 91F OPT My Commission Expires
oFF� \ October 22. 2022
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REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev--5720/21
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