HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11,111.121
Permit Number:
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Building Permit Application
Planning and Development Services ,n
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: 1 Soo
Property Tax ID >l— < _ Lot No.:
Site Plan Name: Block No. I —
Project Name:
DETAILED DESCRIPTION OF WORK: _ �J
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical
$ Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: 5 In nU
OWNER/LESSEE:
Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Utilities: `Sewer _Septic
Name %«.,,,., r;.r%Mr77�PrS Ur)
r`i�ah
Address: J�� /1
.� Stater
City:
Zip Code:
Fax:
Phone No. 7 E
Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
CONTRACTOR:
Roof Pitch
Building Height:
Name: '
Company:
Address: I
City: Stater
Zip Code:_Fax
Phone No 7 %'
E-Mail
State or County�Licens�����
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: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:_______State:
Zip: ne
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: —Not Applicable
Name:
Name:
Address:
Address:
City: - -.
City:
zip: Phone:
Zip: Phone:
UWNLR/ CONTRACTOR AFFIDVIT• Application Is hereby made to obtain a permit to do the work and install itlon 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 ASIocia-tion 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 jobsite before the first inspection. if you intend to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Q,1,iA C-aC�
/
Sworn tQ (or affirmed) and subscribed before me of /
20Q I by
Physical Presence or Online Notarization
this — day of 11n.K'n-&6V--
Name of person making statement.
sun OR Produced Identification,
fir•
AWXiiiI:XW
Cpinln,leHH022053
Type of Identification Aboduced
27 Mill
�Thru Aift)t1 No"
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 5/26/21