HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C
Date: Permit Number:
tJ� a LUr CLC 'R,
r 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:
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: nee
DETAILED DESCRIPTION OF WORK:
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 C <Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of-First Noor:
Cost of Construction: $ ?� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Q Name: _
Address: J5—)000 Qaka(G,pe— Ax Company:
I �/
City: O(�' �\ f e— State: EL Address:
Zip Code: L �iFax: City: State:
Phone No. D �O 7 ip Code: Fax:
E-Mail: ✓1 J1 Phone No
Fill in fee simple Title Holder on n xt page ( if different E-Mail
from the Owner listed above) State or County License
Ll�f_value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
e of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
i
MINOR
,MR,
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 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 ap attorney before commencing work or recording our Notice of Commencement.
Sign re of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF i�L 14.1 4 4
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this,&_day of Sto,&4- 20Z!� by
Name of person making statement.
Personally Known OR Produced Identification ci
Type of Identification Produced
i
(Signature of Notary Public- ate of Florida )
`,,PAY Pvei, HEATHER BURFORD
Commission No. (Seal) ;A/ `�=State of Florida-Notary Public
_• Commission ft GG 183217
My Commission Expires
February 06, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
11 JCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL 34982
T LUCI6 UTILITIES DEP
2300 RGINA AVE
RT PI CE,FL 34982 �l rt
w CRE CARD 11
$ Mr1 ALE .E ADDRESS
cad;
.Y� `� XXXX)(XXXXXXX6992
d; CAPITAL ONE
A0000000011010 IISION LOT
6 BLOCK
`EQ 1726
6atCh p; 6 3 ADDRESS P
INVOICE
Woval Code. 03542P •� � � � �i + �� � jY�l. ` �._
Entry t+letlx�cl. C)p Read
Mode'.
Issuer , MOVE IN/CLOSING DATE
Sr�LE�R90UNT5L12J cation hereby request and authorizes the Utility to render water and/or sewage disposal
the premises described above in accordance with the Utilities present or future rates,
_ rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
$— CUSTOMER COPY CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
CUST SOCIAL SEC/
SIGNr FED ID
NAME OF SPOUSE (�. ��(y a ' y) SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH G �1 �w RECEIVED BY