HomeMy WebLinkAboutBuilding Permit Application All APPLICA77/
E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Permit Number: a.�
RECEIVED
NOV 1 LI? 1
Building Permit Application St.WdaCounty
Planning and Development Services Permitting
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:
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PRUPQSEQ 1MPRQVEMENT EQCATIC�I� s,;. 3 d� .... _I�
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Addres . - 5 C,c> k/M 2c-r D
Property Tax ID#: 3 Z`7 D d O 06 `7 Lot No.
Site Plan Name:C_+kZ:L0 Cu c) C.0 v C_F)��rF2 Block No.
Project Name: Cll�c_
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DETAILED DESCRIPTION aF WQRK
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'New Electrical Meter Second Electrical Meter ' (Affidavit regired)
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ONST INFORMATtO�N
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:$ G 0 o Utilities: _Sewer _Septic Building Height:
OWN E R/LES$E=E CONT CTOR
Name - LFa Name: (`1a tii 4 0
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Address: Q,S(r>S C17_11Tr,_ D2 Company:�"- 41` EL C.12A--,,P-' c>( DP
City: Ps C_ State:J___L Address:z, • ''g ° �L
Zip Code: 7-1`) i!� (n_ Fax: City:1; D' lit`/ State:�L
Phone No. -1 Zip Code? 2 9D Fax:
E-Mail:D• Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
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from the Owner listed above) State or County Licensee Q)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SOPPLE1VdENTAL �QRlSTRUCTfON LIEN LAW iNFOR(VIATI�N
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Arlrlracc: ddracc• I
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable SONDMG.COMPANY: Not Applicable
Name: Name:
Address: Address:
rite. rite-
Zip: Phone: I Zip: Phone: .I
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the-Florida Building Codes and St. Lucie County Amendments!
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in'paying twice for
improvements to your property. A Notice of Commencement must be recorded Iin the public records of St.
�u�is Cvvnty and posted^.n the j%Jsj me be yr s ti is first iii$pcativn. if you intend��o obtain fiiiaiiaiiig, aVnJ'�.71t
wi lender or an attorneybefore commencing work or recording our Notice oflCommencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
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Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this 1a, day of 20�N by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
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(Signature.of Notary . lic-State of Florida)
`. ......
Y DEANNA GIVENS F
Commission Nod��o35� (Seal) Notary Public-State of Florida
y, er Commission#HH 086359
of fo' My Comm.Expires Jan 28,2025
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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