HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
lio L �1L R
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential Ycl-Y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address: v 2-5- AA1.,5 L G U/ltq
Property Tax ID #``: ,.33 ZZ— a O 0 3q _ y Lot No. 3
Site Plan Name: J(? yi,- Fpr 13e— tpLA Block No.
Project Name: ) 0 ✓ti yicp,. \C"&
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit — check all that apply:
(Affidavit required)
K Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric
Plumbing
Total Sq. Ft of Construction:
Sprinklers
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ ;� k � �' = Cr) Utilities: —Sewer —Septic Building Height:
Name `",.e -,� ,, ; 42-eA • Aa� A r
Address: `-12 `-y 5' A .{ c Cst1
City: = _ tate: f C
Name: nr .�
Company:
Address: :3!;;�t 1-,LJ 14CA-11la X-J
Zip Code: 33y 9g Fax: City: po,-A�'o- '-a /�G J, State: .k%t
Phone No. -)::72 _E- Zip Code: 3 3b(_Fax:
Mail: Phone No --72- — &() « q o
Fill in fee simple Title Holder on next page (if different E-Mail &&. ' c r,TA—
from the Owner listed above) State or County Licensee 6-b � 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.
SUPPLEMi NTAL`C„ NSTRUCTI r2 N l_(EN LAVV INF:O�MATo
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 ures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN' G T OWNER: our failure to Record a Notice of Commencement may result in paying twice for
im rove en to
to y ur'property. A Notice of Commencement must be recorded in the public records of St.
L ie Co my di
s ed on the jobsite before the first inspection. If you intend to obtain financing, consult
Ith len er ® 8 ttrnecommencine work or rerording vnur Nntica of Cnmmanr arrant
16
Si kpffU46 of eff Lessee/Contractor as Agent for Owner
ZORIDA
ST E OF
NY
C OF
Sworn to (or affirmed) and s bscribed before me of ,2C Physical Presence or
Online Notarization
this 5 day of U _••_, 20'Zt by
�- c'J A ,,
Name of person making statement.
pua�
DULCE MARTINEZ
Personall K own Q(,.� OR Produced Ide tification
a ' • °
Commission#HH 119702
Type of en ification roduced
N„
Expires May 10, 2025
e�
9TFOFfvoP
BoNedThNBudget NotarySer 1—
L J
(Si ertI4Notary Public- State of Flo ida)
Commission No. (Seal)
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