HomeMy WebLinkAboutDUGASS BUILDING PERMIT APPLICATIONAll 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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential
PROPOSED IMPROVEMENT LOCATION:
Address: Q AleJ ;:5wCifT Cl p , P,4Liv, c a FZ-
Property Tax ID #: Lot No.
Site Plan Narne: LAxe-ac�,lei�7tx�=— FLU+ t83� 5,:,� ra.> >itLa C-F Ui-41J 3' �G��S`�`f lock No.
Project Name:�C'{ ^�
DETAILED DESCRIPTION OF WORK:
iv( ,tip w Z.,V\ ..Lw+ f 21c-T.. 6 G G 5 i T1 c' /)Ac,7—
New Electrical Meter Second Electrical Meter (Affidavit required)
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: N4 Sq. Ft. of First Floor: N14
Cost of Construction: $ ?,Z pr�Cl _ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1u);-!jxg
Name: r_ r_F tvC46(.F
_
Address: 166R-3 *VW%�5We_4zTQ-+iVC 14
an F Company: y: ,�m g A.5 SCE G wre5
e
City: AtL' r I State: R,
Zip Code: B Fax:
Phone No. E-
Address:
City: n)nie�,. T(Y v M State: 1=6
Zip Code: •3-/`!S"+ Fax: iu,4
Phone No % - — ��y/
Mail: ��
Fill in fee simple Title Holder Q13 next page (if different
from the Owner listed abo e t
E-Mail A41Y2 E C� 4,'_ae 1AAJ,0 *55 0CAA rC- S, COAL)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is re rotary Pubic State or Florida
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is require d Robin Sullivan
My Commission GG 920907
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATinN-
DESIGNERANGINEER: Not Applicable
Name: ;
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address: _
City:
Zip: Phone;
MORTGAGE COMPANY. Not Applicable
Name:
Address:
City: State:
Zip: — Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 conflicts with any. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 a posted on the jobs" before the first inspection. If you intend to obtain financing, consult
with lender n attorne efore mmencin work or recording our Notice of Commencement
Signature of owner/ Lessee/Contractor as Agent for owner
STATE OF FLORIDA
COUNTY OF_.__. :;?!�_
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 2f-day of S�rrby` ,20 LI by
Name of person making statement.
�['
Personally Known OR Produced Identification
Type Identification Produced—
(Signatilire of Notary Public- State of Florida)
/}
Commission No. r1i —I �i Di (Seal)
Notary public State M Florida
Robin Sullivan
My Commission GG 929907
} ur ti
Fxpves 11106f2023
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