HomeMy WebLinkAboutBldg Permit App_SignedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i hq ID Permit Number:
Mir
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: �� d("1- 01 re -(CDF
PROPOSED IMPROVEMENT LOCATION:
Address: W/
ii f' ``-vim�' i�
Property Tax ID#: �3�� 1 I owo oclo — Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing / e _ Sprinklers _ Generator Roof 12 Pitch
Total Sq. Ft of Construction: g �'/ Sq. Ft. of First Floor:
Cost of Construction: $ () Noce Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR: j
Name i
Address: P. b. GO)( fqu
City: ffit' } S(\In � W 66 - State:
Zip Code:3_�Av Fax:
Phone No. `%
Mail: VICKI V(2 r((_61-fT)r & aryla; I .
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company: q C
p.
Address: E 1 C .
City: pCnSa C01 a State:
E- Zip Code: ,3 25D3 Fax:
)rn Phone No
E-Mail n r� (iJM
State or County License ) 2 3®
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 I MORTGAGE COMPANY: XNotApplicable
Name: _
Address:
City:
Zip:
Phone
Name:
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
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 1 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 Yotice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jo,Wsite before the first inspection. If you intend to obtain financing, consult
with-ter-4er gr an attorngy beforvrcommencing work or recording your Notice of Commencement.
re o Owner L Con ctor as Agent for Owner
S=TE
S OF FLORIDA\\
COUNTY OFS�,h;
Swor (or affirmed) and subscribed before me of �ysical Presence or Online Notarization
this day of (`) (' 20ZI by
fT, CU Lk_
r ,t
Name of persoh making statement.
/
Personally Known OR Pro ced entification ✓
Type o Identificatio Produced r, bAeT C l
(Signature of Notary P(u'bli to of Florida)
Maw' Moody
Commission No. dylU (Seal)
_ �piARYASs
Notary Public
-State of Florida
rY $ Comm# HH041015
F nires 9 9 2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21