HomeMy WebLinkAboutpermitAll APPLICABLE INFO MU BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Q 2, 02- I Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 01- z . I
Commercial Residential X
CBDG Funding
L PROPOSED IMPROVEMENT LOCATION:
Address: 9 O Lcl1<i'yi'Ack. 1 rolil At
107
Property Tax ID #: q Z Z 500 0 13 3 -- 0 0 0 - I Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
C
New Electrical Meter
alm
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Block No.
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters—WVindows/Doors _ Pond
_ Electric Plumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ '00 Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
Address: 1 �Q <e U ; 5 c�, �t c ;1 `� P " 10 %
City: La(` 5 { State: F t
Zip Code• 3 Ll 5 -z Fax:
Phone No. _ 3 `d i� ? iq E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name•
�s``I 6
Company:
Drf vi P_ lu
€.
Address:
( ritaoze Dr
City:
State: ��
Zip Code: 341F1 Fax:
Phone No_Z
z q,65-65d-Ll
E-Mail
1`` < ' <`,&1; i€[
State or County License C FC, o.9 V OJ5
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ULSIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before rnmmanrinv wnr4 „r _r -- ---
Ulf Ivu1 wuuCe Uf Commencement.
K�$erl
Signat r Les eJContractor as Agent for Owner
STATE OF FLORIDA ��
COUNTY OF L C, e
t,
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of�)r' 20 I by
aYv n I le
Name of p4rson making statement.
/
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Pul'ic- State of Florida)
Commission No. E1 �J CommIGG36 658
(Seal) ' August 25, 2023
Bonded Thra Am Notary
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