HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.�d`�-d °t�3
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Building Permit Application at, bala
Planning and Development Services �fJfA�
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED ,IMPROVEMENT LOCATION:
Address: 12rc>S W (3, Qolyl t rCe C-tnt . Dr.
Property Tax ID #: 332� �VV I ' �(��� + Lot No. '314.
Site Plan Name: Block No.
Project Name: bQ ro n f�CCAd%I'Yl �i
DETAILED DESCRIPTION"OF WORK:
I nS o►I(i nia y New 6trobfS ► MOinwil pull &t"on &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
IElectric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Sprinklers
_ Shutters _ Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
104,Lyl Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Comm n Weaffi-MA&T &Ervf
Name: edWOLr P1
e -
Address: 12Z E LaKt,Company:
ADT COf"Y)MM1,0l
Address: AsYP: ..
City:�.� ... State: _
Zip Code: 1 Fax:
Phone No. �112- 64(0 24q I E-
City: �qI f'1�1 G 1 `i State: FL
Zip Code: 341g o Fax:
Phone No 11 Z Z 200
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Pal rn ci -t
peg' m irs 'R f - wm
State or County License EC '-3Q0 1 SS
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 IN_FORMATION,: '. .
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
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
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 attornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/C ntTactor as Agent for Owner
STATE OF FLORIDA
MAr-h �
COUNTY OF
Sworn to (or affirmed) and suJbscribed before me of Physical Presence or Online Notarization
this 1day of 14 S 201I by
Name of person making statement.
Personally Known OR Produced Identification
Type of Id ced
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
:�yr r� "• EMILY TAYERAS
Notary Public - State of Florida .
Commission x HH 0967.09
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rti°�' My Comm. Expires Feb 23, 2025
Bonded through National Notary Assn.
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Rev 5/20/21