HomeMy WebLinkAboutBuilding Permit Application FAIILICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Permit Number: l L V
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V 10, c` c 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:
PROp05D liVIPROUMENT CATION
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Address: �HID' /'UhA6 or4 �lr 3L1 TJ
Property Tax ID#: '1`1 02 -23 / r b 6 6 2" 1l0-J Lot No.
Site Plan Name: a,-ttA5c, fit!(, Block No.
Project Name: qL'f 20
DETAILED DESCRIPTION OF 1lUORK
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l;� CFI' �C'GT�_.� Jh G'�i nG, al 0 G ln•�'� /`�(ll C.� w:�� �7 �
New Electrical Meter Second Electrical Meter (Affidavit required)
_rt C ONSTRUCTION [N1 R JRM
�'..%':}a. .:.£. _ •. :. .fix. F,
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:$ ?_0 6_0 Utilities: _Sewer _Septic Building Height:
`;OWIUERJLESSEE: J ` ' i t 4,�_ "n Yf 7�% AGONT{p�[L'��ETOR Z' r r` f
Name �, Name: �L,1 �n.` t. C>•'1
Address: Al Company: . W l;
City:: A or-�- I i' f State: AC_ Address: 6119- N(J 6-In � 4^C
Zip Code: 3_�t(jq 2 _ Fax: City: 1) ff Sf LLIS'/(. State: �L
Phone No. E- Zip Code: 3 Ll 11'Z Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail W-f lk,50 a.ram-, C o M,
from the Owner listed above) State or County License At
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If value of construction is 2500 or.more,a RECORDER Notice of Commencement is required.
if value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. C)
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aU1PPEENIENTAICONS`ERU`CTIONt'�EN`'LUIf;IIV�dRMATIf)l�:°ir; u,�Er f "
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DESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
i Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 attorney before commencing work or recording, our Notice of Commencement.
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Signature of Owner/Less a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYCOUNTY OF
Sworn to(or affir et and subscribed before me of Physical Presence or Online Notarization
this , day of G ' 20 a(by
Name of person making statement.
am Pua OSCAR ROCA
PersonallyKnown OR Produced Identification ° `"'•o
� * Commissloe#HH 158050
Type of Identification Produced
�, ExpitesAugu819,2025
kltw ov 8onaedThuBudDetPJolarY
(Signature of Notary Public-State of Florida)
1� 1st
Commission No. 11970 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 20 1