HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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p Building Permit Applic n
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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: O klq A 14A474lan `I
Property Tax ID #: `� 0 Lot No.
Site Plan Name: C Cs"-, Zf S 6�1- Block No.
Project Name: r-( w1+
DETAILED DESCRIPTION OF WORK:
6 9 /\�c ' �t zv' -3:7 1x I
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mec nical _Gas Tank _Gas Piping `Shutteys _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1S 1 (,J i� 11 ' C �,i Utilities: _ Sewer _ Septic Building Height:
O W N ERAESSEE:
CONTRACTOR:
Name:jjQ✓t4v 6ad/tr7_
Company: QLry plc4-P E LIA J%6
Name r)(Offr) PpSAYTS ®fir Ste[
Address:- 1 0 ) %� J:) J�-W otj A-i A
City: & itil+inSState:
Zip Code: �101 9 H 9 Fax:
Phone No. �1 -q 4 - 3
Address:
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City: S2 bA S 4 ✓ State: rL
Zip Code: G Fax: 1lzZ'wt-zC11I
hone No ] Z' 0 �y 33
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E-Mail: ✓
Fill in fee simple Title Holder on next pagd if different
from the Owner listed above)
E-Mail a r) UvV�( Le
State or County"License 9�C lip d 1 A I ��
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.
SUPPLEM.ENTiALCONSTRUCTCON
LIEN LAW
INFORMATION:
DESIGNER/ENGINEER: _ Not
Name:
Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State: _
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not
Name:
Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Clty:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to do the work and Installation as Indicated,
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
which is In conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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,
accessary 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
STATE OF FLORIDA
COUNTY OF ��• Ll c0
Sworn to (or affirmed) and subscribed before me of Physical Presence or. Online Notarization
this 'll of 7kk�41 .202k by
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cal-Nr,Cii Pe,rez
Name of person making statement,
Personally Known � OR Produced Identification
Type ofl a Produced
I
(Signature oNotaryP lic-State of Florida )
��C13c•ictS�3 (Seal eofFia de
Commission No. ) Rig
G 340673
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