HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
'7 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential )(MG)(
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: y k (s o /J 14 ; oI k c, " A l A 2 o,3 Iq
Property Tax ID #: 0 06.7- 6,0z) Lot No.
Site Plan Name:
Project Name:
{ dq�CL A ; rt-2r 3 . S� [ ���5 . S $.o o b k "J
y A CA 4 Fif/ i C n/ F
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
(Affidavit required)
Block No.
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7313.ox) Utilities: _ Sewer _ Septic Building Height:
Nam
Address: K\ Lo * 410 LJ " A,tA*Z42
City: ford V -e rc, State: JL,
Zip Code: 3 qO% 4l !� Fax:
Phone No. 19-1-. 43g- a (o.O E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: -\-eG�•roA4 Vr-nkj,%,
Company: L: vA c ,- ► ►-,
Address: 1 ,' .s
City: 1r) r-( P i e rc a State: F- L
Zip Code: 3�� '� Fax:
Phone No �A 3J-t4 I gc>
E-Mail d "k co 0 L a Ls5 -on,"
State or County License C44 Co S-G q -1 /
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SIJPPLE�VI{ENTA"G t NSTRUCTI'ON LIEN LAW INFaRMATION
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 conflicts with an� applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consul t 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 ures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN[ G T OWNER: our failure to Record a Notice of Commencement may result in paying twice for
im rove ents toy urproperty. A Notice of Commencement must be recorded in the public records of St.
L ie Co my d s ed on the jobsite before the first inspection. If you intend to obtain financing, consult
ith len er a trnev 6afnre cnmmencina work nr rpcnrriinP vniir Nntirp of rnmmPnrPm Pnt
a Lessee/Contractor as Agent for Owner
Si ofZORIDA
ST E OF
C NTY OF
Sworn to (or affirmed) a d subscribed before me of A Physical Presence or Online Notarization
this � day of��t 20?,A by
Name of person making statement.
Per on Ily Known _,ML OR oduced Identification
T e o identif' ation Pr oduc
( ign ure of Notary Publi - St e of Florida)
,PUB�c
DULCE MARTINEZ
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Commission No, (Seal) ? •'"'•
Commission# HH 119702
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Expires May 10, 2025
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