HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ���� Permit Number:
O
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: �e, �pC c5N'D
PROPOSED IMPROVEMENT LOCATION: J
Address: 3 )�� L.it�a !/,f S-Gt L>7✓2 '7�0�'� P.,zcc-e
Property Tax ID #: Z q Z2� - (on ( — on -a — n n p _ O Lot No. 2k— 3 �
Site Plan Name: Block No. —A
Project Name:
DETAILED DESCRIPTION OF WORK:
cJl1/ifI aVl;I,W 7Z r/! 5Y-O /% GCCCGSSUs2/ /Yi /L i lS a./�G/ An 5 f o \
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical
Electric
_Gas Tank
Plumbing
Total Sq. Ft of Construction:
—Gas Piping
Sprinklers
Cost of Construction: $ y' 1)n 0 - 0 0
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof 3 / Z Pitch
Utilities: _Sewer _Septic
Building Height
ID �
OWNER/LESSEE:
CONTRACTOR:
Name L.e)CLY
Name:
S�ULCe-
Address: 3 i `fib L� rla/Q ✓l 54 u /4 V 2
Company:
T 5
City: 'Pi f=K cP State: EL
Zip Code: 3 H q rfZ. Fax:
Phone No. /�l� E-
Address:
3lG/D
City:
Zip Code:
Phone No
Sfya %—�'L— State: -FL
3'e9 9 77 Fax:
�`��—F Z —gd 3 n
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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: _ Not Applicable
MORTGAGE COMPANY. Not Applicable
Name:
_
Name: t
Address:
dress*City:
State:
State:
Zip: Phone
i Phone•
FEE SIMPLE TITLE HOLDER: _ Not Appl cable .41VINIDINGCOMPANY-
_Not Applicable
Name:
e•
Address:
Adder•
City: I
any.
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: A ication Is hereby made to obtain a permit to do the work and Installation as indicated.
1 certify that no work or installation has cornslienced prior to the Issuance of a permit.
St. Lucie County makes no representation that Is ting a pert will authorize the permit holder to build the subj structtre
which conflicts with an appitnbte Homeowners�gon riles. bylaws or and covenams that may restrict or proht such
structure. Please consult with your Homeowner: Asso on and ew 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 re4iew: room addltions,
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 ring
public records of St.
Lucie Counkdndosted on the jobs)t a before the first Inspection. if you intend to obtain financing, consult
with lendEfocalfattorne before mmencing work or recordin ur Notice of Co
lz.Z= mmencement.
oz:
re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF ma' �zr%
Swum to (or affirmed) ��trtnd subscribed before me of
OcphysimM
l Presence or Notarization
this IS dayof_ CGtobu .2021by
)
Name of person making Statement
Personall Known
Y �OR Produced identificationCommission
Type of Identification Produced
.ANTONIO PEREZ GONZALEZ
etc Notary Public • State of Florida
p HH 099121
n.� My Comm. Expires Feb 25, 2025
EN
"Bonded through National Notary Assn.
(Signature of Notary Public -State of Florida)
Commission No. MR e 9 J-/ 2/ (Seat)
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