HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _0 / 2 2021 Permit Number:
9t. L GllL -
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: Plum k D
PROPOSED IMPROVEMENT LOCATION,
Address:
Property Tax ID #:� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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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 Plumbing —Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: obc , 00 Utilities: _Sewer _Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name L i -) &_
Name: e fl
Address: 10 Lu ���, ii A S l 1 f d 6
Company: !3rf 6 2 P/
City: ?6-4 S-E L(kC," e.. _State:FL--
Address: () e � r
Zip Code: 5 2 Fax:
City: (}rt S" L.[LCz t State: ILL
Phone No. �� � `'�c( 0 - 4 ct E-
Zip Code: 34q 5�Z Fax:
Mail:
Phone No 77d- ft-65,;� J
Fill in fee simple Title Holder on next page (if different
E-Mail rf 5ELve,& ut-f
State or County License C FC b e b �
from the Owner listed above)
.. .....v..u«....r.v...a •..ivv W. asaw.=, o nG{.valLPGv 1VULF .0 V► WnUAenvement 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
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
nwrdFR/rniuTQnrrno ACCIMnT.
„NN„LdL,U„ „,ieredy 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, 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 attnrnpv hafnra rnmmant-in(T 1A,f%r1, ,,._r ,._ __ __ -
.....,,.,..,, . 1VULli.c vi wnnnerMernerlt.
Signat r f r(er/ Les e/Contractor as Agent for Owner
STATE OF FLORIDA �� j p�
COUNTY OF C, 5
to L-t�
Swor to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of �P �tr�F� r 2021 by
'ya rV 1A1 Zr nE 16
Name of p6rson making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary 1310(ic- State of Florida) Walf"Un DM]
/� Comm,#GG36 658
Commission No.tT19� � 0 (Seal) : 25,210
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