HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 RS • a t Permit Number:
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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5 Y 6 S '�o�y�,�,t?,1b V Y- - 'Jqqg a
Property Tax ID#: 31-0a • (QIb' 01-) 'U?l?7 ( Lot No.
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
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:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
O
Address: rJ
Company: ��i•�1C SltiecJ
City: State:F-L-
Zip Code: 3IC� g ok, Fax:------__
Phone No. 14Q-1 • L1 Fj;2. • at+y-4- `
Address: J -7 S• Hg -IYi Son .5 t-.
City: r,>4-4A V e r State: Cy
Zip Code: /0 Fax:
Phone No 41O`7 L3k 8 a ' oZ 4 'ty
E-Mail:nlDdr 1 Ata V Z-P -N f'•f'Sl,Ld coM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail r i A t S o
State or County License Cg C / a S 3le 4 S'
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: I
DESIGNER/ENGINEER: _ Not Applicable
Name: e 1 ,In A W.
Address: ►-11-1 S • NAIX Y i 01 S
City: Qt ,iW.41, State:
Zip: Ssb;)Ap Phone c10-1 - aRAa4
FEE SIMPLE TITLEHOLDER: jS Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip: —
Pho
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure, Please consult with your Home Owners 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 Coy and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with ledder or an attorney before commencing work or recording our Notice of Commencement.
gnature of ner/ Lessee/Contractor as Agent for Owner
Signature f tra cense Holder
STATE 0 FLORIDA OSTATE
OF FLORIDA
COUNTY OF V
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or 9 Online Notarization
_ Physical Pres rice or Online Notarization
_ _
this :4q day of () G'fOw , 2021 by
this L day of kAyitAAV0 2021 by
-hA m4-FT4j,mm
rtam SaUI^P 4
Name of person rdaking statement.
Name of person making statem nt.
Personally Known OR Produced Identification -)Q_
Personally Known _� OR Produced Identification
Type of Identification
Type of Identification
Produced L,
14
Produced
CIA'�A �
(Signature of Notary P ic- State of FI Cassidy Berg
(Signature of Nota Public- State Florida q Cassy
Q g, NOTARY PUBLIC
t ¢, NOTARY
Commission No. 9?�0113I0a9 itSTATE OF FL
R IDAmission No. CY1 Ot 310 R-9 -STATE 0
` Comm# GG97
29 Comm# G
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
-7
COMPLETED
Rev. 516120
024