HomeMy WebLinkAboutRevised Building Application (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ((1 - 21
Permit Number: Ja ill - D a b _�l
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:
Property Tax ID #: 3 q 001 •5p-2, - Mjrp (v • nZYD p Lot No. _
Site Plan Name: Ci�6 12L 12�01AV-C_ _ Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 6W Z(pa
_ Generator
Windows/Doors _ Pond
Roof Pitch
n Sq. Ft. of First Floor: _
Cost of Construction: $ ?5 Sou Utilities: —Sewer Septic
1 !!
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
O e
Name: / v A4 Sa,'_
roc
Address: V3
u MAW C+.
Company: f
5AL-i
City: Pkkr(,'e' State: PC.,
Zip Code: 3 f !3g a Fax:
Phone No. 4D 1 R 82 444
Address: 1-7 -7 -7
S aY y i So ►i St-.
City: (') ✓
Zip Code:
Phone No 40 7 •
State: C D
Fax:
;Z Sr - • a.- 4 L4 4
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail I/1► 754 Y i n
U-0--L-12FS 1•--�.1 .cow,
State or County License
Cl?C, 1953Ce
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:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: l
f 0 Vl S
Address:
City:
Zip: %L-ra-1.0 Phone
State:
a a
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
__)(Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Address:
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 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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencinlz work or recording vour Notice of Commencement.
igna u e Owner/ Lessee/Contractor as Agent for Owner
Signature ntr ctor/Lic se Holder
STATE OF FLORIDA Q
STATE OF
COUNTY OF ��
COUNTY OFORID
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or X Online Notarization
Physical Presence or Online Notarization
this day of IyJQI -t ,4 /a ty 202 f by
this / day of J 2021 by
(21 a ,2 -rn W'e.
Name of per n making statement.
Name of person making statement.
Personally Known OR Produced Identification J�—
Personally Known X OR Produced Identification
Type of Identification 1�
{�j�
Type of Identification
Produc94
Produced
(Signature of Notary -Pub is a of Fl�oo a } sidy Berger
(Signature of Notary Public- S ) Cassidy B r
e s° N TARY PUBLIC
Commission No. ��' a S TE OF FLORI
Q °� NOTARY U IC
commission No. 9 9 7 �z'.t S CoATE 0
f
:s Comm# GG97362
rr GG97362I9
wSA 0
Expires /26/2
24
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/lU