HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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IV ° 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: ,vz ,ti u a,zv LlL T,) /fo�sF
PROPOSED IMPROVEMENT LOCATION:
Address: LiOp% fides T �7 /�72Ge+y /y viTA Pj
Property Tax ID It: 2 z-1 di 7 DS Od OC/ Oo o Lot No. 7 4 2
Site Plan Name: Block No. 41
Project Name:
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DETAILED DESCRIPTION OF WORK:
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New Electrical 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 _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: '3 -!;-
Cost of Construction: $ ,ADO
Generator Roof Pitch
Sq. Ft. of First Floor: 3 .S Z'J
Utilities: -Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name PA 674-�-' LL C
Name: Xxe /w/eX ,/tip «"
Address: Z 7 ?N 5 P- L-E79-6LE ' 2
Company: 4,( 3
City: &Ia 57 1 r cr a State: F/
Zip Code: 3 14 Fax:
Phone No. E-
Address: ?lri 3
City: 0&;AZ s% 1 Z-<< State: r
Zip Code: 3.41 f33 Fax:
Phone No 7 L L 2 y cl 11
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail %J7?�v14 7e0r-4 iS
State or County License gf��G % N 2
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 may apply.
In consideration of the granting of this requested permit, 1 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
witp lender or an allornev before commencing work or recording your Notice of Commencement.
Signature of Ow er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA.
COUNTY OF� LIIC
Sworn to (or affirmed) nd s bscr'bed before me of ✓
Physical Presence or
Online Notarization
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Name of person ma ing statement.
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Jason Hendry
eden Personally Known OR Pro ucI tification v
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f I ntific on Pr uced ��
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Expires: February 23, 2023
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