HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Planning and Development Services
Building and Code Regulation Division Commercial Residential Z
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: I ?_ 1 e7 At /,- " fU
Property Tax ID #: �k 3 1-7 -213- W 1 cp 000 - (, Lot No.
Site Plan Name: t,r C., ( je/r M,"11 Block No.
Project Name: ( ct _ _
k- f^ ,l O -A CIM Y_ v' i Q r- !A -NIA) V 1 Sy r / L2 bi L J
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit — check all that apply:
(Affidavit required)
4—Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 1'&V Utilities: _ Sewer _ Septic
ilk F I"Mf
Address:: laj,-, (-�t4 h Ad
City: A0/1-4 State: �C
Zip Code: 3T q5 Fax:
Phone No.1�12-� t 3() E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company: L
Roof Pitch
Building Height:
Address: 56'Y1 L'i ICI C_ Kh�
City: ec ' K',_ V"'g' State:
Zip Code: �--!%04o G Fax:
Phone No'1�2-k000--(4o%%
E-Mail Cyr\ c,' � Lk- nA AA-i r-c-ptn _
State or County License CAA C-0 69 .7 1
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.
SUPPLEMENTALC f NSTRUGTI�N,L(EN.LAW
INFORMATION. Y `'
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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, 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 ures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN' G T OWNER: our failure to Record a Notice of Commencement may result in paying twice for
im rove ents toy ur'property. A Notice of Commencement must be recorded in the public records of St,
L ie Co my d s ed on the jobsite before the first inspection. If you intend to obtain financing, consult
Ith len er.@ a trnevbtnre commencinE work or recordine vour Notice of Commencement.
el
Si of a Lessee/Contractor as Agent for Owner
ST E OF F
C NTY C S� L_44,4iLl
Sworn to (or affirmed) qnd subscribed before me of kX
Physical Presence or Online Notarization
this �2_ day of v�f� v�_, 20 Zi by
Name of person m king statement.
vPU DULCEMARTINEZ
Bc,V
Perso I Known Xc. OR Produced Identification
;oars`..,
* Commission#HH119702
Type f I entificati Produced
Expires May10,2025
Mlo"5,v
BonMTluu8ud98tN0tar1SW*0$
/V J_1(,A
( ig ature of Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS
FRONT
ZONING .
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev S/zu/Ll