HomeMy WebLinkAboutPermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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I c 'Al c E, � " 1- Building Permit Application
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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: \`�-L "-�)C Vo�- o 1�c
Property Tax ID #: -\\ CA c)vz A cxx) - c Lot No. Gs
Site Plan Name: ���.._ _.� �k � Block No. ---I 1
Project Name:
DETAILED DESCRIPTION OF WORK:
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: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name:
Address: ��1� "J\� �-JGCvca_Ct
Company:-'V(e''N\C�
\--Ni'riC-�
City: �2� Stater
Zip Code: Fax:
Phone No. bLA1 2- Ll - 2GO0 E-
Address: 2` 2-
���Y xC A�
City: �� X"aY \
Zip Code: c-1 GC',-\
Phone No 6:3U1 --N-1 '
State: L-
Fax:
cb--FA
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Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail- I � t,- vnc--1\r)(.CQ C�Gi- QLA"r)
State or County License_
n vague or consirucuon is /�uu or more, a Ktc.UKULu 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 INFORMATION:
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 5t. 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 commencing work or recording our Notice of Commencement.
Kev5/20/21
Signature of Owner/ Les ee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF— Sr Lvc-j�6;-
Sworn to (or affirmed) and subscribed before me of Ac Physical Presence or Online
Notarization
this a3 dayof So _ PT;9wbt;*-- , 20'2-{ by
Name of person making statement.
Personally Known Js4 l` OR Produced Identification
Type of Identification Produced
(5i at re o ota ublic- tare of Florida)
Commission No_ q (Sea[) Notery Public State of Florira
�,►�"�
Michael James Mills
+� My Commission GG 8701124
Expires 431 WONREVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED