HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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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: bp_��
PROPOSED IMPROVEMENT LOCATION:
Address: 1 �1 L�c *)d cd-.a6S
Property Tax ID #: aM 15 -'( L.�' 1- L�1 Lot No. a`
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter X Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
Y Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction: 31 O
Gas Piping
Sprinklers
Shutters
Block No.
(Affidavit required)
Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor: L41 3'1
Cost of Construction: $ la i ono Utilities: —Sewer � Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name (OS
Name: -3c6n Crv�
yove_
Address: k-A%�odka.A&S '�:)r,JR-
Company: ('--wz�
&s� lXWS ,SnL•
City: Q Sk, LO-6 Q- State: r--
Zip Code: 3`i0\sa- Fax:
Phone No. 1 � 2 - 3� �Q - 9-k-3t E-
Address: Skl Ss_�
eSL 6kA,
City: 'pu-k Sk.�.uci
Zip Code: J`i �15 3
Phone No - 1�I L- �J��9-
State:
Fax:
7�oS3
Mail: pory-,a..lo� a_ 1( C,ow�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
1 d e� . or -
State or County icense
C-&f- I S awl-3q
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: �4 Not Applicable MORTGAGE COMPANY:
Name:
Name: Address:
Address: City
City: State: y' phone:
y Phone Zip:
Zip:
FEE SIMPLE TITLE HOLDER: -�D Not Applicable
Name: _
Address:
City: —
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
__/Not Applicable
State:
of 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 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
_._ _ _,� �� ., k ,41F .- pnrina Xninrle nr rPrnrding vnur Notice of Commencement.
with lehuer UI an aLL01IIC ucl vic i..vi n......�.n-
-
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4�::)
4Z — -
Signat re of Owner/ Lessee/C nt ctor as A t for Owner
STATE OF FLORIDA.
COUNTY OF •LuCk-e -
Sworn to (or affirmed) and subscribed before me of
_VPhysical Presence or Online Notarization
this IL day of . 2021 by
Name of person making statement.
Personally Known XZ OR Produced Identification
Type of Identification Produced
(Signature of N ar ublic- State o lorida)
Kil Finley
Notary Public
Commission No." C>e;aS U (Seal)
State of Florida
aVAICEISN'�
Comm# HH082506
Expires 1/19/2025
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Rev 5