HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
9a L UILM I w
V 01n n
Planning and Development Services
Permit Number:
Building Permit Application
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 3AIIV - 5A9 - dabs - 000 - 0
Site Plan Name: Poro l z UIQ�Cki
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ .20, r/O/J, b r�
Gas Piping
Sprinklers
_ Shutters
Residential
(Affidavit required)
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
�9
Windows/Doors _ Pond
Roof 2 /Z Pitch
Utilities: _ Sewer _ Septic Building Height: /O'
OWNER/LESSEE:
CONTRACTOR:
Name OU3464f ��Ur�i6e,'
Name: wICe 2=2zig
Address: Vf 12 " Su y,,I IZa�
Company:-t-95 ``The )*42/ .eaf� 4
City: OdYf 6z L//Li P_ State: Fie-
Zip Code: 3`'l q X3 Fax:
Phone No. -?-?;2- SAS - OSSL E-
Address: 3//00 1 GdOalP/ .Si{
City: s:4iw1/ State: _5L-
Zip Code: 3y99;7 Fax:
Phone No
Mail: NIL%
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailnifSQfhrwslo/ihnL�T
State or County License
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 INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
ame:
_ Not Applicable
Address:
A es
City:
Zip: Phone
State,
Cit
Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Appli ble
NDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applic tionreby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has comment d prior to the issuance of a permit.
St. Lucie County makes no representation that is gr ting a hermit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners As ciation 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 groperty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and po5k6don the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an aittze6ev before commencine work or recordine vour Notice of Commencement.
Sig fur r/ Lessee/Contractor as Agent for Owner
ST OF FLORIDA
C NTY OF YYl a t1�
i
Sworn to (or affirmerJ) nd subscribed before me of _Physical
this day of 0 ✓ 20r1 by
Presence or _Online Notarization
7
e'4c.-_ (_av0.
Name of person making statement.
Personally Known t/ OR Produced Identification
Type of Identification Produced
(Signature of Notary Pub(t'%tA Af Florida)
; o�IY OAli,
Commission No. Coe xs-3d/ (seal) :`1•�s
THERESA JAFFE
NotaryPubllc- StateofFlorida
e`
Commission # GG 202301
My Comm. Expires APr 1, 2022
Bonded through National Notary Assn.
REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21