HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
��o L U C 0L `
0
' R 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:
PROP05ED IMPROVEMENT LOCATION: G,�
Address: ZZ 0 S�Q� �'1C�
Property Tax ID 4 L-- ` L (L�
r' L Site Plan Name: _ l CSk-ir14 IsOa—Cy
0
Project Name:
M
�eIKA--Ipc 3l-k�161
New Electrical Meter )( Second Electrical Meter (Affidavit required)
INFORMATION:
Lot No. T
Block No.
Additional work to be performed under this permit —check all that apply:
—Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
�CElectric
_ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �`-� i� 3 Utilities: —Sewer _Septic Building Height:
OWNER/L
Name 1
Address:
City: i State:
Zip Code: - Fax: -
Phone No. S i E-
Mail: 1 G
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: 1 It
Company: '
-�-
Address.
N -
City:
State:
Zip Code: 10
Fax: n 0.1
Phone-
E-Mail �YYY1l�R�F�-•tip
State or County LicenseC��=}?�(
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
LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY:
Name: eS`��t�' Name:
Addre n Address:
City: State: City: _
Zip: "� Phone Bb V� Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
:-Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip:
Phone:
_ Not Applicable
State:
Not Applicable
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 a osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender o an att6rney before commencing work or recording your Notice of Commencement.
�r r4 Notary Public State of Florida
AiA= Emily Kuhn
Signature of er/ Lessee/Contractor as Agent for Owner My Commission HN 104795
hy' Expires 03115/2025
STATE OF FLORIDA f
COUNTY OF
SW r affir ) n ubscrib d b ore me of Physical Presence or Online Notarization
thi day of 2by
Name of person maki
Personally Known
Type sf Identification
statem
OR Produced Identification
(Signature o> NotarVP4blic- State of Florida)
Commission No. C k3leteal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
py .t,, Notary PUDIIC ara�C
i9 �i^ Emily Kuhn
My Commission HH 104795
Expires 03/15/2025
'x or
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW ' REVIEW REVIEW REVIEW