HomeMy WebLinkAboutPermit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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)462-15S3 Fax: (772)462-1S78 CBDG Funding
PERMIT APPLICATION FOR:
'�OI�(�5"�C� 1(tli�I��VEMN�` LC7CAT[C3N
Address:
Property Tax ID#:_:3 3 1-7 S-C)2- U 2-7 �- cn �,� � --1 Lot No.
Site Plan Name: ' X 4A-- Block No.
Project Name:' A
Ei`AILE� OSRIPTIONCF"tNORK
-a �t ru&Le r
New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTION INFOR(1fIATON
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: Sq. Ft. of First Floor:
Cost of Construction: $ "1 Q_ , bib Utilities: _Sewer _Septic Building Height:
OU1tNR/ E55E .. CONTRA:CI`OR
Name ft a Name:
Address: $c 1) c') s y\& C_A- Company: �i h�� r cam. i r 1216A dI
City: �„-1 'S), t I A e-," C Stater Address: .3 I tAC,0-,�o P-,L
Zip Code: 3 g �_Fax: City: �0 �'- V3 off- State: L
Phone No. -11 2-- "2,LJ ', V E- Zip Code:3-3%6 oo. Fax:
Mail: R- r-r"r✓n f 1 �r�- �:� Phone No -1 Z-b D 04 a��
Fill in fee simple Title Holder on next page (if different E-Mail ,,, c p W1 �_ �.ny,d 5� c�,� .�/ ,•�[ ,
from the Owner listed above) State or County License ; 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.
SUPPLEMENTAL C f NSTRUGTIQN LIEN l AW IN - MTIQ(V
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.
1 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 ylgtVres,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARN[ G T OWNWyt
our failure to Record a Notice of Commencement may result in paying twice for
im rove ents tr'property,A Notice of Commencement must be recorded in the public records of St.
L ie Co my ed on the jobsite before the first inspection. If you intend to obtain financing, consult
ith len er ame e commencin work or recordin our Notice of Commencement.
Si ofZORIDA
a Lessee/Contractor as Agent for Owner
ST E OF
C NTY O F S �i.<t C' e—
Sworn to(or affirmed)ands bscribed before me of ,Physical Presence or Online Notarization
this W day of 20ZI by
Name of erson making statement.
Perso ally nown OR Produ d Id ntification
Type of Id ntificati n Produced
(Sin ure of Notary Public Scate of F orida)
"Ov ru",o DULCE MARTINEZ
Commission No. (Seal) * * Commission#HH 119702
N `oe Expires May 10,2025
9fFOF F�OQ Bonded Thru Budget Notary Services
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