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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: E P • a0t", , '?021 Permit Number:
�` Co C,L.Icm1
V Building Permit Application
Planning and Development Services V
Building and Code Regulation Division Commercial Residential VVVV
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: C 314 %F14t11 PP11 IA0 A S--F
Property Tax ID #: 3,4o 9 - -10 3 - o o ,34 - ©o o Lot No. 14 S 15-
Site Plan Name: Block No.�
Project Name: D, M 1 i Vz O aF
DETAILED DESCRIPTION OF WORK:
JZEIAQ\/E E-X 1S-T1#,j 14G�L1�-7 T2009-- giEPLALE-
'TA1 N L-A YMEN7 2 (a GAu G.
rd ha1 1EF `Tp+ I- F'A N C dF <Y S i I: m
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
Electric _ Plumbing _ Sprinklers _ Generator '�Roaf
Total Sq. Ft of Construction:
SE51
Cost of Construction: $ _SO d "
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name 10M P I M M C'T—]
Name: F, P-IolT=- ik 5-
y i--,
Address: L3) It A ?, A P^/V 0 A 6
Company: M); �4�0�.1p�A
R
DC7�' kts`l �
City: FD/fT A/�FR cf Stater
Zip Coder `� Fax:
Phone No. E-
Address: SA DD 1 3
rd k
City:\IC90 15fi-AC-0
Zip Code: 32Cyb 0
Phone No 7 9 Zr 5
Fax:
_ State: r
?-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C_ 5 off n
r tol- t -41
State or County License C. GC 1 3
6 5-'t 6
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 TITLE HOLDER: _ 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
witfhj.ender or an attorney before commencing work or recording your Notice of Commencement.
Signal ure of Owner/ Less /Contrac r as Agent for Owner
STA1J OF FLORID�__
COUNTY OF la^
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this QZ1, day of 2QZ0 by
Name of person making statement.
Personally Known /" OR Produced Identification
Type of Identification Produced
c
(Signature of Public- State of Florida)
Notary
Commission No. (Seal)
P- Notary PubllcState oifferida
Carmen H Esty
g My Commission 1301000470
Expires 061 6/2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
HeV 5/ZU121