HomeMy WebLinkAboutpermit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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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:
PROPOSED IMPROVEMENT LOCATION;
Address: �I I�j r-1fd_rr�r��C t l ' r� C�
Property Tax ID#: I�:' ���1 C'C�I e ` �`G (� Lot No.
Site Plan Name: , , ,�,.,-3v._�\��W'OIvv£_ c� o�, �Cr E_ Block No.
Project Name: CIV)DJ7, OWE CQ--
DETAILED DESCRIPTION OF WORK:
New Electrical Meter F,
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
Gas Tank
_�<Rlumbing
Total Sq. Ft of Construction: Iq I L
Cost of Construction: $
OWNER/LESSEE:
Name(. "ks-tC)rrv-\ ! A— +-A L4
Gas Piping
_ Sprinklers
Shutters
(Affidavit required)
Windows/Doors
Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Address:
City. E State:
Zip Code�,J-4M�-6 Fax: -1 1e� 333-�39C
Phone No. {=� E-
MaiI:� EZ yes It ri I'� COS'
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name CVC ,1 i
Companyci-axr'L' ►!� MD,(i s� rt�C��u,►���c
Address: � \\UI 1- CI rlr uY�Gy- �C�T
City: gf+Ti State:
Zip Code: �,1q"Qc Fax: -�3 -DsctCa
Phone No '-i-; -3f�l - D2)ZS3
E-Mail Q (-'CCtCf ll]litt l^fD -1 • Ccr���
State or County License ' �'.C�' I JL^ "G 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:
Name: _
Address:
City:
Zip:
Phone
Not Applicable
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
State:
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 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 and posted on the jq,bsite before the first inspection. If you intend to obtain financing, consult
-with-lender or an attorney bpfgre commencing work or recording our Notice of Commencement.
re of OwneT,7�'Cessee/Contractor-As'Agent for Owner
STATE OF FLORIDA.
COUNTY OF n0-- Lct,e
Swo n (or affir►need) and subscribed before me of )I Physical Presence or Online Notarization
this day of L- ctoL,-, 2021 by
Name of person making statement.
Personally Known �O OR Produced Identification
Type of Identification Produced_
(Signature of Notary Public- State of Florida)
Commission No. C )�3 (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
SABRINA BUTLER
MY COMMISSION # GG 163728
EXPIRES: Decener 8, 2021
Bonded ThN�YPublic Unde**n
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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