HomeMy WebLinkAboutSLC blding perm appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
9�1ra LYUrs, .
Q ! D.�
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residentiat(K
PERMIT APPLICATION FOR: P51 `/1�lCli1 - �Go
PROPOSED IMPROVEMENT LOCATION:
Address: SDI (15� 01� FO(A- PWI`�i2 r 3qq
Property Tax ID fi: aJ l 0 ZZS GoO Lot No 5
Site Plan Name: Block No. C
Project Name: F)(0C'J Y1
DETAILED DESCRIPTION OF WORK:
0-0U-42 Cc-LV(eO1 SYlIVn61�k (00f i-C I).0C�-lnz7, YP01QCe
OlStMMCLOWa wood, N(GC0 del � Qdk r-1 aACLOV 16AAAAQA4 l nSta
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 _ Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: �100 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
r)OW
Name: f- -(-'LC t
Address:sli0-)AnfI5e Dr—
Company: 05CC)S *fWfA
4- (eJ22krSi
City: f 0r� Pre r (LZ State: TL
Zip Code: L 5 Fax:
Phone No.
Address: 15bLj lti 35�h
� 4-
City: I m C 1 �-y
Zip Code: V G � 0 Fax:
Phone No -7-72,- 52 5 - IG'c
State: C_
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailc ISCo Oft
1 6 SIR I L
State or County License (
Z 7
wiouuu1un o cwu or more, a ntLunueu notice otCommencement 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
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
State:
City: State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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
is in any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict with
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,
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 attorneybefore commencin work or recordin our Notice of Commencement.
D Ok---
Signs re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�T l e
COUNTY OF
Sworn o (or affirmed) and subscribed before me of Physical Presence or Online Notarization
thisay of 54 W0," V � by
r20
of
J-1--1 r_ \c Yk I C) ('4 r I
Name of person making statement.
P na own OR Pr duc entification
ype o e ification Produced L_ l`A Y 1l) Q.
(Signature of Notary Pub Late o orida )
`spr o NANCY HAGERFIORST
(l -7 C� Nota Public
Commission No. & Seal)
(
_
o State of Florida
= Comm#HH167992
y t 9�
EvIres8/23/202S
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