HomeMy WebLinkAboutBuilding Permit Application - Waller All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: OC�odc-l� Permit Number:
oo Luur,_,
Building Permit Application
Planning and Development Services V
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)452-1553 Fax: (772) 452-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED�yIMPROVEMENT LOCATION:
Address: 11 0 2- W/A1'T&7R G A R4 r-- /�d I' k W y
Property Tax ID#: - � / y ® Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: g6O 51'—� Sq. Ft.of First Floor:
Q i
Cost of Construction: $ )"goo Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRA OR:
Name L� e D /A N� GIALLC/Z Name: _ c -3 7o °
Address: ql 02, V!/j,/7nr_ 6A<0 c. l�X ompany: EY:S 646Vo C&IV <'Q� Al _._.
City: F-o/L�G /�/o 2 C- state: A= Add ress: �5 t 0 O -4 3 rA A\r c
Zip Code: 1 Fax: City:VFgG Z3 CAC 14 State:
Phone No. E- Zip Code: 3 Z`l iv b Fax:
Mail: Phone No_ Z_ 5- 3` Z- t q
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License C—�C 11 5 0 S 3 0�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
im is to your property. A Notice of Commencement must be recorded in the public records of St.
cl County and po n jobsite before the first inspection. If you intend to obtain financing,consult
with lender r a torn bef re commencingwork or recordingour Notice of Commencement.
Signatur of Own n L ssee/Co tractor as gent for Owner
STATE F FLORIDA
COON OF /5 !� 4 i' -e--
POP
Sworn to(or affirme and su�scr'bed before me of LiPhy ' ' nce$JPryP„bt� arization
this day of ��'..f�-_ 02, b rtoa�°` e p mm.$osty�e prfi)arrna
88'?8iZ 3G 908478
Name of person makipg statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21