HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� IJ�21 Permit Number:
U.
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
PERMIT APPLICATION FOR:
C
Address: _?=_Ib0 C-) Inds'-s Ct_L+ 0-4 c 12A Psi i7--L 34-PB-1
Property Tax ID #: C)Q\0 • 010 • Q Lot No.
Site Plan Name: Block No.
Project Name:
t,4DVF-1 4 20-1005.0 2
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit- check all that apply:
Mechanical
Electric
_Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Cost of Construction: $ _32 • `:'f Utilities
Name J OYYI I %?121eV9C_-
Address: 2L C tGI CS CL-,A- �
City: pS State: EL
Zip Code: 3L-LQ'2_j Fax:
Phone No.--n? • 5 (G • I L63
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
_ Pond
Sewer _ Septic Building Height:
Pitch
Name:_ _01( n i G. CAI-(ACG
Company: �F C IrS
Address: 45i S-G Dr -
City: limos I State: f=i
Zip Code: -j!+Q 2Lo Fax:-n-1-LYwO,_105
Phone No --n?- • V4,eO • '_1(030
E-Mail 71)C6GS4 e- D17G �rt'x _C�GY�(Sr�c1.Ct
State or County Licens
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:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
UVVNtK/ (,UN I KAL I UK 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 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 your Notice of Commencement.
Sign re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA,
COUNTY OF,
Sworn to (or affirmed) and subscribed before me of V Physical Presence or Online Notarization
this 10 day of t n i 202-1 by
Name of person making statement.
Personally Known '✓ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Commission No. t1Tt �g7 �q1 Seal r �`vPUB MICHAELWALZAK
(Seal) �� .,�,woo Commission # HH 087991
s c` Expires February 2, 2025
9TF0F E' Bonded Ttuu Budget Notary Servioes
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