HomeMy WebLinkAboutMidway rdAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �;J1/y%� /
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Permit Number:
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` L `' `` ` � `� Building Permit Application
Planning and Development Services
Building and Code Regulotion Division Commercial Residential ��
7300 Virginio Avenue, Fort Pierce FL 34987
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATION:
Address: �� 0� /�Ci1�l%(%lt�i9L/ /�`> �/�if/G`y�� �l
Property Tax ID #:
Site Plan Name:
Project Name: j��(LU����
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
(Affidavit required)
Lot No.
Block No.
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: $ �!-��LO Utilities: _Sewer _Septic Building Height: __
OWNER/LESSEE: CONTRACTOR:
Name 5����/(;-Ur 1_`jj� /")ATF�/✓
Address: O/td v
City: _ O � [/�'it! State:
Zip Code: _��i 9.SS Fax:
Phone No. �%7z'-��'L- 92,t 4 E_
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: �9 i/� . f /3��ityi�i
�
Company= ��/n/i=/'/
G`�lF/�/r,�-/ �'� �
Address:
ftJ `�
City: %
!L� State:
Zip Code: _ �¢ j.�7 Fax:'77�_ �'j�_2 f7i
Phone No `z _ ,y
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E-Mail
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State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ff value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ut51GNER/ENGINEER: Not Applicable
Name: _
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address
City:
Zip:
Phone:
MORTGAGE COMPANY: _Not Applicable
Name: _
Address:
City:
Zip:
Phone:
State:
BONDING COMPANY: _Not Applicable
Name: _
Address:
ccy:
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 restriR 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 �obsite before the first inspection_ If you intend to obtain financing, consult
with lender or an attorne before commencin work or recordin our Notice of Commencement_
.�
STATE OF FLORIDA
COUNTY OF �� �
�hysical Presence or
as Agent for Owner
Sworn to (or affirmed) and subscribed before me of
this �_ day of
i9��� r � 20� by
Name of person making statement.
Personally own � OR Produced Identification
Type of 1 ificatio oduced
/� �
of Notary
Comrnission No.
REVIEWS
- State of
(Seal)
FRONT ZONING
COUNTER REVIEW
Online Notarization
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• � Jens 27, 2024
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PLANS VEGETATION
SUPERVISOR REVIEW REVIEW
REVIEW
SEq TURTLE I MANGROVE
REVIEW REVIEW
DATE
RECEIVED
DATE
rnMPLETE�
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