HomeMy WebLinkAboutBuilding Permit Application UpdatedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 111" of l ZI
Permit Number:
P L_ 0 c E cBuilding 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:
PROPOSED IMPROVEMENT LOCATION:
0
Address: 2,L4p—j _';�nT La c2 tVD f 0K-7 10I612U -EL 39clyy
Property Tax ID #: Lot No._I
Site Plan Name: Block No. if (Ir
Project Name: P_o be VT 0. i< IZj-,%eIZ
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)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator _v"' Roof Pitch
Total Sq. Ft of Construction: 2 , Z() C) Sq. Ft. of First Floor:
Cost of Construction: $ -2- , CCU 0 . LTV Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name aohf 12T p. -T--P12b•F f2.
Name: 1 an M o ecJ e s
Address:Z 0-1 5.ajhT WU-2, Iblvol
Company: XM 00oPnq
4 P_f eoxon
City: pl -e2 U State: -FL-
Zip Code: 2>L4 q�-1 4 Fax:
Phone No.(1') 2-) OU - 2-5)1 E-
Address: ��
r�tz
City: IjA11:�70,6
Zip Code: 3271 3
Phone No-( 3Zl
State: Fi-
Fax:
q 25 9
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ' fS
- Y-rstorofton.cvw
State or County License CCC
P 3 zq Ip 1
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:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name: _
Address:
City: _
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 consu t 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 cW attorney before commencing work or recording our Notice of Commencement
re f caner/ a/Contractor as Agent for owner
rTATE OF FLORIDA-
COUNTY OFC�U�C
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this J/8� day of Cart 6 E'y 20_4 by
Name of person making statement.
Personally Known OR Produced Identification
Ty of I ti ication Produ i_'�1'7lOt'f�a C/
C-4e
(Si at a of Notary Public- State of Florida)
Commission No.6b3425�3 Sea[)
;o�yvape�..
PATRICIA SANCHEZCOUSQ
�
Notary Public - State of Florida
9'
iI
Commission # GG 34 6634
My Comm. Expires Jun 6. 2023
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Rev 5/ 20/ 21