HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: "! / 20 140 Z I Permit Number:
LU LL
Y 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: \f0_ Lr- V\'n',-(OJT Y,�P1('k C_9_ MQ pf' t'
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 131 2- F5M- Q0YJ - 000 -- I Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 11 2.00
OWNER/LESSEE:
Gas Piping
Sprinklers
(Affidavit required)
Shutters _
_ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer
Name Jl1 rIX(Ai'1J Z)(JYY]1'U
Address:%U) Patio e az (Ar(I[I
City:5(1�Y_A pitrcR_ State.rl
Zip Code: �Aq S l Fax:
Phone No. 3_Z� �� r g 4 E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Windows/Doors Pond
Roof Pitch
Septic Building Height:
CONTRACTOR:
Name: -1�C.S
Company: _ 1 wder 0=biw
Address: `� `1.S N N :H\-N\(
City: State:
Zip Code: 32-�p� Fax. -1-7 2LiC -
Phone No �-1�7 2-�>D) - 3��E
E-Mail j� l ong61� eniumhir)_ . Urn
State or County License CFC 1430LAO
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.
DATE
RECEIVED
DATE
COMPLETED
ev
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name:
Address: Name:
City: Address:
State: City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable BONDING COMPANY:
Name:
Address:
Name:
City:
Address:
Zip: Phone:
City:Zip:
Phone:
Not Applicable
State:
Not Applicable
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 any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which ma a I
In consideration of the granting of this requested permit, I do hereby agree that I will in all respectsy pp y
perform the
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.work
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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA r "`` • _
COUNTY OF
Sworn_ to (or affirmed) and subscribed before me of
this , � 1 day of 20 by
Name of person making statement.
Personally Known e.� OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida
PAMELA ANN KING
Commission No. (Seal) Notary Public - State of Florida
Commission HH 120744
My Comm. Expires Jul 31, 2025
Borded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE COUNTER REVIEW REVIEW REVIEW MANGROVE
REVIEW REVIEW REVIEW
Physical Presence or Online Notarization